Information Collection

Health and Development Survey

IC 227866 under ICR 201708-0920-011 · OMB 0920-1219.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Health and Development Survey	Form
Health and Development Survey Attachment 6.c - SEED Teen Health and Development Survey_ver Feb 2018.docx	Form
Attachment 6.c.1 - Annotated SEED Teen Health and Development Survey_ver Feb 2018.docx Annotated Health and Development Survey	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	none	Health and Development Survey	Attachment 6.c - SEED Teen Health and Development Survey_ver Feb 2018.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Epidemiologic Studies and Surveilance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 142

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	142	142
Annual IC Time Burden (Hours)	95	95
Annual IC Cost Burden (Dollars)	1,647	1,647

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Annotated Health and Development Survey	Attachment 6.c.1 - Annotated SEED Teen Health and Development Survey_ver Feb 2018.docx	02/28/2018

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