Questionnaire about Sibling of Index Child

Factors Influencing Children's Potential Exposures to Indoor Contaminants

Documents and Forms

Document Name Document Type
Questionnaire about Sibling of Index Child Form
Sigling Questionnaire AppndxD2 Questionnaire Sibling.docx Form

Information Collection (IC) Details

IC Title:	Questionnaire about Sibling of Index Child	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Sigling Questionnaire	AppndxD2 Questionnaire Sibling.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: Epidemiologic Studies and surveillance of disease problems	FR Citation: 57 FR 62812

Number of Respondents: 22	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	88	88
Annual IC Time Burden (Hours)	29	29
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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