Information Collection

Children Hopital of Los Angeles/Project AIM

IC 201759 under ICR 201203-0990-004 · OMB 0990-0382.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0382 can be found here:

Documents and Forms

Document Name Document Type
0990-0382Attachment C_CHLA.pdf Other-survey
PPA_FU survey_CHLA_Response to OMB_051412.docx Other-response
New items for Followup_response to comments_to OMB_051412.docx New items for Followup_response to comments_to OMB_051412 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Children Hopital of Los Angeles/Project AIM	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
Other-response			PPA_FU survey_CHLA_Response to OMB_051412.docx		Yes	Yes	Printable Only
Other-survey			0990-0382Attachment C_CHLA.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 453	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	906	906
Annual IC Time Burden (Hours)	544	544
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
New items for Followup_response to comments_to OMB_051412	New items for Followup_response to comments_to OMB_051412.docx	05/15/2012

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