Information Collection

Infant Health Follow-Up Form

IC 222498 under ICR 201703-0920-001 · OMB 0920-1143.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1143 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Infant Health Follow-Up Form	Form and Instruction
Infant Health Follow-Up Form ATT_D_USZPR_Infant_Follow_Up_Revised 21SEP2016.docx	Form and Instruction

IC Title:

Infant Health Follow-Up Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	Infant Health Follow-Up Form	ATT_D_USZPR_Infant_Follow_Up_Revised 21SEP2016.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems; 09-20-0136

FR Citation: 57 FR 62812

Number of Respondents: 1,100

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	33,000	33,000
Annual IC Time Burden (Hours)	8,250	8,250
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.