6-Month Follow-up: Session 1 (Parent Modules)

Children's Health after the Storms (CHATS)

Documents and Forms

Document Name Document Type
6-Month Follow-up: Session 1 (Parent Modules) Form and Instruction
CHATS Attachment N_revised_02272012 CHATS Attachment N_revised_02272012.docx Form and Instruction
CHATS Attachment N OMB_6-Month Session_1_Spanish.docx Spanish Follow-up IC Document

Information Collection (IC) Details

IC Title:	6-Month Follow-up: Session 1 (Parent Modules)	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 and Instruction	none	CHATS Attachment N_revised_02272012	CHATS Attachment N_revised_02272012.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 225	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	225	225
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Spanish Follow-up	CHATS Attachment N OMB_6-Month Session_1_Spanish.docx	04/16/2012

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