CDC EHDI Hearing Screening and Followup Survey (HSFS)

Early Hearing Detection and Intervention Hearing Screening and Follow-up survey

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.