Information Collection

Parent-Child Enrollment Questionnaire

IC 229192 under ICR 201803-0920-014 · OMB 0920-1190.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Parent-Child Enrollment Questionnaire	Form and Instruction
Parent Child Enrollment Questionnaire Att B9_Parent_Child_Enrollment_Questionnaire_08FEB2018_clean.docx	Form and Instruction
Parent Child Enrollment Questionnaire - Spanish Att C9_Cuestionario_inscripcion_padre_bebe_08FEB2018_clean.docx	Form and Instruction
Att B9_Parent_Child_Enrollment_Questionnaire_08FEB2018_track.docx Parent Child Enrollment Questionnaire - trkchg	IC Document
Att C9_Cuestionario_inscripcion_padre_bebe_08FEB2018_track.docx Parent Child Enrollment Questionnaire - Spanish - trkchg	IC Document

IC Title:

Agency IC Tracking Number:

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 and Instruction	none	Parent Child Enrollment Questionnaire	Att B9_Parent_Child_Enrollment_Questionnaire_08FEB2018_clean.docx		No		Paper Only
Form and Instruction	none	Parent Child Enrollment Questionnaire - Spanish	Att C9_Cuestionario_inscripcion_padre_bebe_08FEB2018_clean.docx		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	Previously Approved
Annual Number of Responses for this IC	900	0	900
Annual IC Time Burden (Hours)	225	-75	300
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Parent Child Enrollment Questionnaire - trkchg	Att B9_Parent_Child_Enrollment_Questionnaire_08FEB2018_track.docx	03/26/2018
Parent Child Enrollment Questionnaire - Spanish - trkchg	Att C9_Cuestionario_inscripcion_padre_bebe_08FEB2018_track.docx	03/26/2018

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