Information Collection

Child Maltreatment Surveillance (Sample Web-based Assessment

IC 191930 under ICR 201002-0920-001 · OMB 0920-0847.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0847 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 5.pdf	Other-Word

IC Title:

Child Maltreatment Surveillance (Sample Web-based Assessment

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Word			Attachment 5.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 432,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	432,000	0	0	0	0	0
Annual IC Time Burden (Hours)	72,000	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.