Sickle Cell Disease Treatment Demonstration Program (SCDTDP) Evaluation - Health Survey

Sickle Cell Disease Program Evaluations

Documents and Forms

Document Name Document Type
Form 5 Sickle Cell Disease Treatment Demonstration Program (SCDTDP) Evaluation - Health Survey Form
5 Short Form 8 Health Survey (adult) Indicator Crosswalk for SF36-SF8 and PedsQL-PedsQL SF 15.xls Form

Information Collection (IC) Details

IC Title:	Sickle Cell Disease Treatment Demonstration Program (SCDTDP) Evaluation - Health Survey	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
Form	5	Short Form 8 Health Survey (adult)	Indicator Crosswalk for SF36-SF8 and PedsQL-PedsQL SF 15.xls		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 630	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,260	0	1,260
Annual IC Time Burden (Hours)	126	-189	315
Annual IC Cost Burden (Dollars)	0	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.