Information Collection

Pediatric Case Subject Screening Process

IC 210431 under ICR 201402-0920-014 · OMB 0920-1013.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1013 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920 Pediatric Case Subject Screening Process	Form and Instruction
0920 Attachment D_Pediatric case and control Screening Forms Attachment D_Pediatric case and control Screening Forms 1_24_14.docx	Form and Instruction
SPANISH TRANSLATION_Attachment K_Pediatric Case and Control Screening Forms_1_24_14.docx SPANISH TRANSLATION_Attachment K_Pediatric Case and Control Screening Forms	IC Document

IC Title:

Pediatric Case Subject Screening Process

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 and Instruction	0920	Attachment D_Pediatric case and control Screening Forms	Attachment D_Pediatric case and control Screening Forms 1_24_14.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 141

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	141	141
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SPANISH TRANSLATION_Attachment K_Pediatric Case and Control Screening Forms	SPANISH TRANSLATION_Attachment K_Pediatric Case and Control Screening Forms_1_24_14.docx	02/17/2014

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