MUH Saliva Collection - children

Adoption, Health Impact and Cost of Smoke-Free Multi-Unit Housing Policies

Documents and Forms

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

Information Collection (IC) Details

IC Title:	MUH Saliva Collection - children	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
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 %

	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

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.