Information Collection

ATTACHMENT C27: Pediatric Quality of Life (Teen 13 plus)

IC 179850 under ICR 201002-0920-008 · OMB 0920-0747.

Documents and Forms

Document Name Document Type
Form 26 ATTACHMENT C27: Pediatric Quality of Life (Teen 13 plus) Form and Instruction
26 ATTACHMENT C27: Pediatric Quality of Life (Teen 13 plus) Attachment C previously approved instruments.zip Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	ATTACHMENT C27: Pediatric Quality of Life (Teen 13 plus)	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	26	ATTACHMENT C27: Pediatric Quality of Life (Teen 13 plus)	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: 175	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	175	-223	398
Annual IC Time Burden (Hours)	15	-118	133
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.