Information Collection

MUH Saliva Collection - children

IC 204449 under ICR 201309-0920-011 · OMB 0920-1004.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 10A(e) Protocol for Saliva Collection 8 29 2012.docx	Instruction
clean 12 13 13 Att 10-A1(s)_MUH Child Assent for Saliva 5_16_13.docx Saliva Collection Assent Children Spanish	IC Document
clean 12.17.13 Att 10-A1(e)_MUH Child Assent for Saliva 5_16_13.docx Saliva Collection Assent Children	IC Document

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
Instruction			Att 10A(e) Protocol for Saliva Collection 8 29 2012.docx		No	No	Printable Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Saliva Collection Assent Children Spanish	clean 12 13 13 Att 10-A1(s)_MUH Child Assent for Saliva 5_16_13.docx	12/19/2013
Saliva Collection Assent Children	clean 12.17.13 Att 10-A1(e)_MUH Child Assent for Saliva 5_16_13.docx	12/19/2013

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