Information Collection

Kids Genes and Health

IC 209620 under ICR 201403-0925-011 · OMB 0925-0700.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Kids Genes and Health	Form and Instruction
1 Screenshot: Kids, Genes, and Health Attach 13 Screenshot Kids, Genes, and Health-Shaw.pdf	Form and Instruction
Attach 12. Survey Kids, Genes, and Health-Shaw.pdf Attach 12	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
Form and Instruction	1	Screenshot: Kids, Genes, and Health	Attach 13 Screenshot Kids, Genes, and Health-Shaw.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30,000

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	30,000	30,000
Annual IC Time Burden (Hours)	8,500	8,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attach 12	Attach 12. Survey Kids, Genes, and Health-Shaw.pdf	03/24/2014

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