Information Collection Request

The Healthy Communities Study: How Communities Shape Childrens Health (NHLBI)

ICR 201307-0925-004 · OMB 0925-0649 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 13 School Liaisons Form and Instruction New Available
Form 11 District Food Service Administrator/Manager Form and Instruction New Available
Form 8 Physicians/Medical Secretaries Form and Instruction Modified Available
Form 1 State Health Department Employees Form and Instruction Removed Available
Form 10 Physical Education Instructiors Form and Instruction Modified Available
Form 9 Food Service Personnel Form and Instruction Modified Available
Form 7 Key Informants Form and Instruction Modified Available
Form 6 Key Informats (screening) Form and Instruction Modified Available
Form 5 Children Form and Instruction Modified Available
Form 4 Parents/Caregivers (who refused) Form and Instruction Modified Available
Form 3 Second Parents Form and Instruction Modified Available
Form 2 Parents/Caregivers Form and Instruction Modified Available
Form 1 Parents (screening) Form and Instruction Modified Available
FINAL_HCS_SSB_7-11-13.docx Supporting Statement B Uploaded 2013-07-24 Available
FINAL_HCS_SSB_ATTACH 2_NOMINATION FORM_Jan 2013.xlsx Supplementary Document Uploaded 2013-07-24 Available
FINAL_HCS_SSB_ATTACH 1_CCSC MEMBERS_Jan 2013.docx Supplementary Document Uploaded 2013-07-24 Available
FINAL_HCS_SSA_ATTACH 1_GLOSSARY_Jan 2013.docx Supplementary Document Uploaded 2013-07-24 Available
FINAL_HCS_SSA_ATTACH 2_BEE ROSTER_SEP 2011.docx Supplementary Document Uploaded 2013-07-24 Available
FINAL_HCS_SSA_ATTACH 3_NHLBI COUNCIL ROSTER_SEP 2011.docx Supplementary Document Uploaded 2013-07-24 Available
FINAL_HCS_SSA_ATTACH 4_TOOLKIT_Jan 2013.docx Supplementary Document Uploaded 2013-07-24 Available
FINAL_HCS_SSA_ATTACH 21_NCCOR LETTER_Jan 2013.pdf Supplementary Document Uploaded 2013-07-24 Available
FINAL_HCS_SSA_ATTACH 22_SUBCOMMITTEES_Jan 2013.docx Supplementary Document Uploaded 2013-07-24 Available
FINAL_HCS_SSA_ATTACH 23_IRB APPROVAL_Jan 2013.pdf Supplementary Document Uploaded 2013-07-24 Available
FINAL_HCS_SSA_ATTACH 24_PRIVACY ACT MEMO_Jan 2013.pdf Supplementary Document Uploaded 2013-07-24 Available
FINAL_HCS_SSA_ATTACH 14_MOD WINDSHIELD SURVEY_Jan 2013.docx Supplementary Document Uploaded 2013-07-24 Available
HCS_OMB Memo RE revision_2-12-13 revised 2 28 13.docx Supplementary Document Uploaded 2013-07-24 Available
FINAL_HCS_SSB_ATTACH 3_STAT POWER ANALYSIS_July 2013.docx Supplementary Document Uploaded 2013-07-24 Available
FINAL_HCS_SSA_ATTACH 10_KI LETTER_Jan 2013.docx Supplementary Document Uploaded 2013-07-24 Available
FINAL_HCS_SSA_ATTACH 11_KI BROCHURE_Jan 2013.docx Supplementary Document Uploaded 2013-07-24 Available
FINAL_HCS_SSA_7-11-13.docx Supporting Statement A Uploaded 2013-07-24 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
207892 School Liaisons Form and Instruction New
207891 District Food Service Administrator/Manager Form and Instruction New
199554 Physicians/Medical Secretaries Form and Instruction Modified
199553 State Health Department Employees Form and Instruction Removed
199552 Physical Education Instructiors Form and Instruction Modified
199551 Food Service Personnel Form and Instruction Modified
199550 Key Informants Form and Instruction Modified
199549 Key Informats (screening) Form and Instruction Modified
199548 Children Form and Instruction Modified
199547 Parents/Caregivers (who refused) Form and Instruction Modified
199546 Second Parents Form and Instruction Modified
199545 Parents/Caregivers Form and Instruction Modified
199544 Parents (screening) Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
08/31/2016 36 Months From Approved 01/31/2015
69,010 0 90,880
29,505 0 33,145
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 69,010 90,880 0 0 -21,870 0
Annual Time Burden (Hours) 29,505 33,145 0 0 -3,640 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No