Information Collection

Discussion Guide for Children Grades K-1

IC 197473 under ICR 201104-0920-017 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att G-1a. Children K-1_Discussion Guide.doc	Instruction
Att G-2. Children K-4_Parental Consent.doc Att G2 - Parental Consent	IC Document
Att G-3. Children K-4_Youth Assent Form.doc Att G3 - Youth Assent	IC Document

IC Title:

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			Att G-1a. Children K-1_Discussion Guide.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 16

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	16	16
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att G2 - Parental Consent	Att G-2. Children K-4_Parental Consent.doc	04/13/2011
Att G3 - Youth Assent	Att G-3. Children K-4_Youth Assent Form.doc	04/13/2011

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