Information Collection

Congential Heart Survey To Recognize Outcomes, Needs, and well-beinG (CH STRONG)

IC 220010 under ICR 201803-0920-008 · OMB 0920-1122.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1122 CHSTRONG Cogenital Heart Survey To Recognize Outcomes, Needs, and well-beinG Congential Heart Survey To Recognize Outcomes, Needs, and well-beinG (CH STRONG)	Form
Form 0920-1122 CHSTRONG Encuesta Cardiaca Congenita para Reconocer los Resultados, las Necesidades y el Bienestar Congential Heart Survey To Recognize Outcomes, Needs, and well-beinG (CH STRONG)	Form
0920-1122 CHSTRONG Cogenital Heart Survey To Recognize Outcomes, N Att. 3 - English Survey v 2.pdf	Form
0920-1122 CHSTRONG Encuesta Cardiaca Congenita para Reconocer los Att. 13 - Spanish Survey v 2.pdf	Form
Att. 6 - Online Survey.pdf Att. 6 - CH Strong (screenshots)	IC Document

IC Title:

Agency IC Tracking Number:

0920-1122

Is this a Common Form? No

IC Status: Modified

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	0920-1122				Yes	Yes	Fillable Fileable
Form	0920-1122				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Epidemiological Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 1,661

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,661	1,661
Annual IC Time Burden (Hours)	554	554
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att. 6 - CH Strong (screenshots)		03/13/2018

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

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