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Evaluation of Uniform Donor History Questionnaire and Evaluation of Violence Against Children Survey (VACS)- Malawi
NCHS Questionnaire Design Research Laboratory
OMB: 0920-0222
IC ID: 204892
OMB.report
HHS/CDC
OMB 0920-0222
ICR 201205-0920-001
IC 204892
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:
2022-12-21 - Revision of a currently approved collection
2021-08-16 - Revision of a currently approved collection
Documents and Forms
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
Information Collection (IC) Details
View Information Collection (IC)
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:
Document Type
Form No.
Form Name
Instrument File
URL
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
Federal Enterprise Architecture Business Reference Module
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 %
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
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.