Information Collection

Neurological Exam - Hammersmith Infant Neurologic Exam / Evaluation of Cerebral Palsy

IC 227554 under ICR 201707-0920-007 · OMB 0920-1194.

Documents and Forms

Document Name Document Type
Neurological Exam - Hammersmith Infant Neurologic Exam / Evaluation of Cerebral Palsy Form and Instruction
Hammersmith Infant Neurologic Exam (HINE) Att. 8A- Neurologic Exams.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Neurological Exam - Hammersmith Infant Neurologic Exam / Evaluation of Cerebral Palsy	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 and Instruction	NA	Hammersmith Infant Neurologic Exam (HINE)	Att. 8A- Neurologic Exams.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136 - Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 235	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	235	235
Annual IC Time Burden (Hours)	39	39
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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