Information Collection

Customer Service - HEADS UP Rocket Blades

IC 220790 under ICR 201405-0920-002 · OMB 0920-1009.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1009 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Customer Service - HEADS UP Rocket Blades	Form and Instruction
Child Survey - HEADS UP_Rocket Blades Child Survey_HEADS UP - Rocket Blades.doc	Form and Instruction
Parent Survey - HEADS UP_Rocket Blades Parent Survey_HEADS UP-Rocket Blades.docx	Form and Instruction
Attachment A_Add HEADS-UP-Rocket Blades_ICRO.docx Participation Announcement	IC Document
Attachment B_ Participant Consent Form HEADS UP_IncICRO.docx Participant Consent	IC Document
GenIC Request_HEADS UP-Rocket Blades_IncICRO.docx GenIC Request	IC Document

IC Title:

Customer Service - HEADS UP Rocket Blades

Agency IC Tracking Number:

16XC

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	NA	Child Survey - HEADS UP_Rocket Blades	Child Survey_HEADS UP - Rocket Blades.doc	NA	No		Paper Only
Form and Instruction	NA	Parent Survey - HEADS UP_Rocket Blades	Parent Survey_HEADS UP-Rocket Blades.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 36

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	36	36
Annual IC Time Burden (Hours)	36	36
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Participation Announcement	Attachment A_Add HEADS-UP-Rocket Blades_ICRO.docx	03/28/2016
Participant Consent	Attachment B_ Participant Consent Form HEADS UP_IncICRO.docx	03/28/2016
GenIC Request	GenIC Request_HEADS UP-Rocket Blades_IncICRO.docx	03/28/2016

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