Information Collection

Sickle Cell Disease and Newborn Screening Program (SCDNBSP) Evaluation - MDP SCD Questioniare

IC 197487 under ICR 201204-0915-001 · OMB 0915-0344.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ATTACH_D_NCEC_SCDNBSP_Instruments_11_14_11 revision.docx	Instruction
1 SCD Questionnaire Form Clean Minimum Database Project SCD Questionnaire Form_4_5_12.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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			ATTACH_D_NCEC_SCDNBSP_Instruments_11_14_11 revision.docx		Yes	No	Printable Only
Form and Instruction	1	SCD Questionnaire Form	Clean Minimum Database Project SCD Questionnaire Form_4_5_12.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 140

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	280	280
Annual IC Time Burden (Hours)	126	126
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.