Safe to Sleep National Champions Tracking and Feedback Form

Generic Clearance to Support the Safe to Sleep Campaign at the Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD)

OMB: 0925-0701

IC ID: 214191

Information Collection (IC) Details

View Information Collection (IC)

Safe to Sleep National Champions Tracking and Feedback Form
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 National Champions Tracking and Feedback Screenshots Attachment 3_0925-0701_National Champions Tracking and Feedback Form_Screenshots_rev_12-5-14.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

250 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 250 0 250 0 0 0
Annual IC Time Burden (Hours) 125 0 125 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Clearance Form National Champions 0925-0701_GC Form_National Champions Tracking and Feedback Form_Govt.doc 12/09/2014
Cover Memo National Champions 0925-0701_Sub-study Memo_National Champions Tracking and Feedback Form_Govt_12-9-14.doc 12/11/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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