Information Collection

Evaluation of Uniform Donor History Questionnaire and Evaluation of Violence Against Children Survey (VACS)- Malawi

IC 204892 under ICR 201205-0920-001 · OMB 0920-0222.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Evaluation of Uniform Donor History Questionnaire and Evaluation of Violence Against Children Survey (VACS)- Malawi	Form and Instruction
Attachment 1 Uniform Donor History Questionnaire Attach 1 - Uniform Donor Qnne.docx	Form and Instruction
What to do when a loved one dies-A survivor's checklist Attach 3c - Survivor's Checklist.pdf	Form
Attachment 1: Violence Against Children Survey - Malawi: QDRL VACS Malawi Attach 1 - Qnne.docx	Form
QDRL OMB-10-day combo letter-1106 2012.doc QDRL OMB-10-day combo letter-1106 2012	IC Document
Attach 3a - MD Grief & Loss Therapists.pdf Attach 3a - MD Grief & Loss Therapists	IC Document
Attach 3b - LLF Support Services.pdf Attach 3b - LLF Support Services	IC Document
Attach 3d - What Now.pdf Attach 3d - What Now	IC Document
QDRL_VACS_Malawi_Attach_2-Flyer_v2[1].docx Flyer for Malawi	IC Document
Attach_2abc_-_Uniform_Donor_flyer[1].docx Flyer for Uniform Donor	IC Document
Attach 3 QDRL-ERB-VACS Malawi - approved by ERB 1219 2012.doc Malawi ERB Protocol	IC Document
QDRL Malawi ERB approval memo.docx ERB Approval Memo - Malawi	IC Document
QDRL Uniform Donor History 10-day letter- 1219 2012.docx Mini Supporting Stmt for Uniform Donor	IC Document
QDRL VACS Malawi 10-day letter-final 1219 2012.doc Mini Supporting Stmt Malawi	IC Document

IC Title:

Evaluation of Uniform Donor History Questionnaire and Evaluation of Violence Against Children Survey (VACS)- Malawi

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Attachment 1 Uniform Donor History Questionnaire	Attach 1 - Uniform Donor Qnne.docx	Yes	Yes	Fillable Fileable
Form	None	What to do when a loved one dies-A survivor's checklist	Attach 3c - Survivor's Checklist.pdf	Yes	Yes	Fillable Fileable
Form	None	Attachment 1: Violence Against Children Survey - Malawi: Age 13-24 years	QDRL VACS Malawi Attach 1 - Qnne.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population

FR Citation: 49 FR 37693

Number of Respondents: 65

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	65	0	0	0	0	0
Annual IC Time Burden (Hours)	75	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
QDRL OMB-10-day combo letter-1106 2012	QDRL OMB-10-day combo letter-1106 2012.doc	11/16/2012
Attach 3a - MD Grief & Loss Therapists	Attach 3a - MD Grief & Loss Therapists.pdf	11/16/2012
Attach 3b - LLF Support Services	Attach 3b - LLF Support Services.pdf	11/16/2012
Attach 3d - What Now	Attach 3d - What Now.pdf	11/16/2012
Flyer for Malawi	QDRL_VACS_Malawi_Attach_2-Flyer_v2[1].docx	12/20/2012
Flyer for Uniform Donor	Attach_2abc_-_Uniform_Donor_flyer[1].docx	12/20/2012
Malawi ERB Protocol	Attach 3 QDRL-ERB-VACS Malawi - approved by ERB 1219 2012.doc	12/20/2012
ERB Approval Memo - Malawi	QDRL Malawi ERB approval memo.docx	12/20/2012
Mini Supporting Stmt for Uniform Donor	QDRL Uniform Donor History 10-day letter- 1219 2012.docx	12/20/2012
Mini Supporting Stmt Malawi	QDRL VACS Malawi 10-day letter-final 1219 2012.doc	12/20/2012

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