Information Collection

Parent-Child Follow-Up Questionnaire

IC 229193 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⚠️ Notice: This information collection may be referencing outdated material.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
Parent-Child Follow-Up Questionnaire	Form and Instruction
Parent-Child Follow-Up Questionnaire - English Att B10_Parent_Child_Followup_Questionnaire_09272017.docx	Form and Instruction
Parent-Child Follow-Up Questionnaire - Spanish Att C10_Cuestionario_de_seguimiento_para_padre_y_nino_01NOV2017.docx	Form and Instruction

IC Title:

Parent-Child Follow-Up 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 and Instruction	NA	Parent-Child Follow-Up Questionnaire - English	Att B10_Parent_Child_Followup_Questionnaire_09272017.docx	NA	No		Paper Only
Form and Instruction	NA	Parent-Child Follow-Up Questionnaire - Spanish	Att C10_Cuestionario_de_seguimiento_para_padre_y_nino_01NOV2017.docx	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	3,600	3,600
Annual IC Time Burden (Hours)	900	900
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.