Information Collection

ATTACHMENT C12: Parents' Questionnaire (Mental Health)

IC 179835 under ICR 201002-0920-008 · OMB 0920-0747.

Documents and Forms

Document Name Document Type
Form 11 ATTACHMENT C12: Parents' Questionnaire (Mental Health) Form and Instruction
11 ATTACHMENT C12: Parents' Questionnaire (Mental Health) Attachment C previously approved instruments.zip Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	ATTACHMENT C12: Parents' Questionnaire (Mental Health)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	11	ATTACHMENT C12: Parents' Questionnaire (Mental Health)	Attachment C previously approved instruments.zip		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136 - Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 178	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	178	-783	961
Annual IC Time Burden (Hours)	15	-225	240
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.