Information Collection

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

IC 43622 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Attach_4A_Directions_for_EHDI_Survey.docx Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Early Hearing Detecton and Intervention Hearing Screening and Follow-up survey	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
Instruction			Attach_4A_Directions_for_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: 57	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	57	57
Annual IC Time Burden (Hours)	10	10
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.