Parents (screening)

The Healthy Communities Study: How Communities Shape Children?s Health (NHLBI)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0649 can be found here:

Documents and Forms

Document Name Document Type
Form 6 Parents (screening) Form and Instruction
6 Family Screener HCS_SSA_ATTACH 6_FAMILY SCREENING_SEPTEMBER 2011 FINAL for OMB.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Parents (screening)	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 and Instruction	6	Family Screener	HCS_SSA_ATTACH 6_FAMILY SCREENING_SEPTEMBER 2011 FINAL for OMB.docx		No	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56,550	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	56,550	56,550
Annual IC Time Burden (Hours)	9,614	9,614
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.