Information Collection

Early Hearing Detecton and Intervention Hearing Screening and Follow-up survey

IC 43622 under ICR 201702-0920-015 · OMB 0920-0733.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Early Hearing Detecton and Intervention Hearing Screening and Follow-up survey	Form and Instruction
Screenshots for CDC EHDI Hearing Screening and Follow-up Attach_4C_2013_screenshots_Rev.pdf	Form and Instruction
CDC EHDI Hearing Screening and Follow-up Survey (HSFS) Attach_4B_HSFS_2013.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	None	Screenshots for CDC EHDI Hearing Screening and Follow-up Survey (HSFS)	Attach_4C_2013_screenshots_Rev.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	None	CDC EHDI Hearing Screening and Follow-up Survey (HSFS)	Attach_4B_HSFS_2013.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 55

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-55	55
Annual IC Time Burden (Hours)	-220	220
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.