Child Maltreatment Surveillance (Sample Web-based Assessment

Voluntary Product Satisfaction and Usability Assessment

Documents and Forms

Document Name Document Type
Attachment 5.pdf Other-Word

Information Collection (IC) Details

IC Title:	Child Maltreatment Surveillance (Sample Web-based Assessment	Agency IC Tracking Number:

IC Status: Removed

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
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 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-432,000	432,000
Annual IC Time Burden (Hours)	-72,000	72,000
Annual IC Cost Burden (Dollars)	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.