Information Collection

Application for Healthy Kids Challenge - Individual/Household

IC 192126 under ICR 201006-0584-001 · OMB 0584-0555.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Screene-Shots for Challenge Wireframes.docx	Other-Application
Appendix C Contest Application C 9-20-2010.docx	Other-application
Appendix_C_-_Contest_Official_Rules[1].doc Contest Rules	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Other-Application			Screene-Shots for Challenge Wireframes.docx	www.AppsforHealthyKids.com	Yes	Yes	Fillable Fileable Signable
Other-application			Appendix C Contest Application C 9-20-2010.docx	www.AppsforHealthyKids.com	Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	1,381	1,381
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Contest Rules	Appendix_C_-_Contest_Official_Rules[1].doc	09/29/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.