Information Collection

Strengths and Difficulties Questionnaire

IC 229184 under ICR 201710-0920-013 · OMB 0920-1190.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1190 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Strengths and Difficulties Questionnaire	Form
Strengths and Difficulties Assessment - ENGLISH Strengths and Difficulties ENGLISH.pdf	Form
Strengths and Difficulties Assessment - SPANISH Strengths and Difficulties SPANISH.pdf	Form

IC Title:

Strengths and Difficulties Questionnaire

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	NA	Strengths and Difficulties Assessment - ENGLISH	Strengths and Difficulties ENGLISH.pdf	NA	No		Paper Only
Form	NA	Strengths and Difficulties Assessment - SPANISH	Strengths and Difficulties SPANISH.pdf	NA	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0113 - Epidemic Investigation Case Records System

FR Citation: 51 FR 42466

Number of Respondents: 900

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	900	900
Annual IC Time Burden (Hours)	75	75
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.