Information Collection

Resident Saliva Collection

IC 204430 under ICR 201210-0920-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Resident Saliva Collection	Form and Instruction
Saliva Collection Att 10A(e) Protocol for Saliva Collection_8 29 2012.docx	Form and Instruction
Att 10A-1(e)_Child Assent Saliva Sample.docx Child Assent - English	IC Document
Att 10A-1(s)_Child Assent Saliva Sample_8 30 2012.docx Child Assent - Spanish	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	Saliva Collection	Att 10A(e) Protocol for Saliva Collection_8 29 2012.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Child Assent - English	Att 10A-1(e)_Child Assent Saliva Sample.docx	09/27/2012
Child Assent - Spanish	Att 10A-1(s)_Child Assent Saliva Sample_8 30 2012.docx	09/27/2012

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