Information Collection

Child Pretest - Screenshot

IC 209244 under ICR 201311-0925-001 · OMB 0925-0685.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0685 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10 Child Pretest - Screenshot	Form
10 Child Pretest Attachment 24 - Screenshot Child Pretest - MDF.zip	Form
Attachment_7_-_Data_collection_instrument_-_Child_questionnaire_Pretest_MDF[1].pdf Child Pretest	IC Document

IC Title:

Child Pretest - Screenshot

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	10	Child Pretest	Attachment 24 - Screenshot Child Pretest - MDF.zip		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: SORN 02-25-0200

FR Citation: 67 FR 60741

Number of Respondents: 200

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	200	200
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Child Pretest	Attachment_7_-_Data_collection_instrument_-_Child_questionnaire_Pretest_MDF[1].pdf	11/06/2013

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