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SEARCH Health Questionnaire (Youth )
SEARCH for Diabetes in Youth Study
OMB: 0920-0904
IC ID: 211580
OMB.report
HHS/CDC
OMB 0920-0904
ICR 201705-0920-019
IC 211580
( )
Documents and Forms
Document Name
Document Type
Att 4b.1_Health Questionnaire (Young Adult_ Feb 2014).pdf
Other-WORD
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
SEARCH Health Questionnaire (Youth )
Agency IC Tracking Number:
0920-0904
Is this a Common Form?
No
IC Status:
Removed
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
Other-WORD
Att 4b.1_Health Questionnaire (Young Adult_ Feb 2014).pdf
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems
FR Citation:
57 FR 62812
Number of Respondents:
710
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
0
0
0
-710
0
710
Annual IC Time Burden (Hours)
0
0
0
-178
0
178
Annual IC Cost Burden (Dollars)
0
0
0
0
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.
