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

Sickle Cell Disease Program Evaluations

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Sickle Cell Disease and Newborn Screening Program (SCDNBSP) Evaluation - MDP SCD Questioniare	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
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 %

	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

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.