Parents (screening)

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

Documents and Forms

Document Name Document Type
Form 1 Parents (screening) Form and Instruction
1 Family Screener FINAL_HCS_SSA_ATTACH 5_FAMILY SCREENING_Jan 2013.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Parents (screening)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	1	Family Screener	FINAL_HCS_SSA_ATTACH 5_FAMILY SCREENING_Jan 2013.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 39,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	39,600	-16,950	56,550
Annual IC Time Burden (Hours)	6,600	-3,014	9,614
Annual IC Cost Burden (Dollars)	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.