Information Collection

MUH Resident Post-intervention Children's Module - LA

IC 204446 under ICR 201309-0920-011 · OMB 0920-1004.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Resident Survey Post-int- children's module section G MUH Resident Post-intervention Children's Module - LA	Form
Resident Survey Post-int - children's module section G Spanish MUH Resident Post-intervention Children's Module - LA	Form
Resident Survey Post-int- children's module section G clean 12.17.13Att 9A(e)_MUH Resident Baseline Survey.doc	Form
Resident Survey Post-int - children's module section G S clean 12.17.13 Att 9A(s)_MUH Resident Baseline Survey_12.15.13.doc	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	none	Resident Survey Post-int- children's module section G	clean 12.17.13Att 9A(e)_MUH Resident Baseline Survey.doc		Yes	No	Fillable Printable
Form	none	Resident Survey Post-int - children's module section G Spanish	clean 12.17.13 Att 9A(s)_MUH Resident Baseline Survey_12.15.13.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	63	63
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.