Interview with Children Grades 2-4

Formative Research for and Community Uptake of the Eagle Books and Youth Books for American Indians and Alaska Natives

Documents and Forms

Document Name Document Type
Interview with Children Grades 2-4 Form
Discussion Guide for Grades 2-4 H-1 Children Grades 2-3-4 Discussion Guide.doc Form
H-2 Children Grades K-4 Parental Consent Form.doc Att H2 - Parent Consent IC Document
H-3 Children Grades K-4 Youth Assent Form.doc Att H3 - Youth Assent IC Document

Information Collection (IC) Details

IC Title:	Interview with Children Grades 2-4	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
Form	none	Discussion Guide for Grades 2-4	H-1 Children Grades 2-3-4 Discussion Guide.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

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 %

	Approved	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

Title	Document	Date Uploaded
Att H2 - Parent Consent	H-2 Children Grades K-4 Parental Consent Form.doc	07/20/2011
Att H3 - Youth Assent	H-3 Children Grades K-4 Youth Assent Form.doc	07/20/2011

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