Information Collection

CDC EHDI Hearing Screening and Followup Survey (HSFS)

IC 192922 under ICR 201005-0920-004 · OMB 0920-0733.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0733 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attach_4A_Directions_for_EHDI_Survey.docx	Instruction
2 CDC EHDI Hearing Screening and Follow-up Survey (HSFS) Attach_4B_EHDI_Survey.docx	Form

IC Title:

CDC EHDI Hearing Screening and Followup Survey (HSFS)

Agency IC Tracking Number:

Is this a Common Form? No

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
Instruction			Attach_4A_Directions_for_EHDI_Survey.docx		Yes	Yes	Fillable Fileable
Form	2	CDC EHDI Hearing Screening and Follow-up Survey (HSFS)	Attach_4B_EHDI_Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	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.