SEARCH Health Questionnaire - Youth/ & Parent Versions

SEARCH for Diabetes in Youth Study

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0904 can be found here:

Documents and Forms

Document Name Document Type
4b1_health questionnaire young adult cohort.pdf Other-WORD
4b2_health questionnaire parent cohort.pdf Other-WORD

Information Collection (IC) Details

IC Title:	SEARCH Health Questionnaire - Youth/ & Parent Versions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			4b1_health questionnaire young adult cohort.pdf		Yes	Yes	Fillable Printable
Other-WORD			4b2_health questionnaire parent cohort.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 51 FR 42449

Number of Respondents: 1,420	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,420	1,420
Annual IC Time Burden (Hours)	355	355
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.