CDC EHDI Hearing Screening and Followup Survey (HSFS)

Early Hearing Detection and Intervention Hearing Screening and Follow-up survey

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0733 can be found here:

Documents and Forms

Document Name Document Type
Attach_4A_Directions_for_EHDI_Survey.docx Instruction
2 CDC EHDI Hearing Screening and Follow-up Survey (HSFS) Attach_4B_EHDI_Survey.docx Form

Information Collection (IC) Details

IC Title:	CDC EHDI Hearing Screening and Followup Survey (HSFS)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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
Instruction			Attach_4A_Directions_for_EHDI_Survey.docx		Yes	Yes	Fillable Fileable
Form	2	CDC EHDI Hearing Screening and Follow-up Survey (HSFS)	Attach_4B_EHDI_Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	0	0	0	0	0	0
Annual IC Time Burden (Hours)	0	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	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.