Information Collection

ATTACHMENT C14: Parent Social Isolation/Support

IC 179837 under ICR 201002-0920-008 · OMB 0920-0747.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 13 ATTACHMENT C14: Parent Social Isolation/Support	Form and Instruction
13 ATTACHMENT C14: Parent Social Isolation/Support Attachment C previously approved instruments.zip	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form and Instruction	13	ATTACHMENT C14: Parent Social Isolation/Support	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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	178	168	10
Annual IC Time Burden (Hours)	6	5	1
Annual IC Cost Burden (Dollars)	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.