Health Assessment Form

Health Assessment Form, Public Health Investigation Form: Non-TB Illness, and Public Health Investigation Form: Active TB

OMB: 0970-0509

IC ID: 229902

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Health Assessment Form
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 Health Assessment Form Health Assessment Form (Clean).docx Yes Yes Fillable Printable

Community and Social Services Social Services

ORR Division of Children's Services Records  81 FR 46682

195 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 105,690 0 5,370 0 0 100,320
Annual IC Time Burden (Hours) 38,048 0 16,981 0 0 21,067
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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