Information Collection

Parent-Child Follow-Up Questionnaire

IC 229193 under ICR 201803-0920-014 · OMB 0920-1190.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Parent-Child Follow-Up Questionnaire	Form
Parent Child Followup Questionnaire Att B10_Parent_Child_Followup_Questionnaire_08FEB2018_clean.docx	Form
Parent Child Followup Questionnaire - Spanish Att C10_Cuestionario_seguimiento_padre-nino_08FEB2018_clean.docx	Form
Att B10_Parent_Child_Followup_Questionnaire_08FEB2018_track.docx Parent Child Followup Questionnaire - trkchg	IC Document
Att C10_Cuestionario_seguimiento_padre-nino_08FEB2018_track.docx Parent Child Followup 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	none	Parent Child Followup Questionnaire	Att B10_Parent_Child_Followup_Questionnaire_08FEB2018_clean.docx		No		Paper Only
Form	none	Parent Child Followup Questionnaire - Spanish	Att C10_Cuestionario_seguimiento_padre-nino_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	3,600	0	3,600
Annual IC Time Burden (Hours)	600	-300	900
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Parent Child Followup Questionnaire - trkchg	Att B10_Parent_Child_Followup_Questionnaire_08FEB2018_track.docx	03/26/2018
Parent Child Followup Questionnaire - Spanish - trkchg	Att C10_Cuestionario_seguimiento_padre-nino_08FEB2018_track.docx	03/26/2018

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