Information Collection

Social Participation Form Pediatric

IC 246644 under ICR 202102-0920-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-20QS Social Participation Form Pediatric	Form and Instruction
0920-20QS Social Participation Form Pediatric 11_Social Participation Form Pediatric.pdf	Form and Instruction
0920-20QS Social Participation Form Pediatric 11_Social Participation Form Pediatric.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-20QS

Is this a Common Form? Yes

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	0920-20QS	Social Participation Form Pediatric	11_Social Participation Form Pediatric.pdf		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	3	-61	64
Annual IC Time Burden (Hours)	0	-8	8
Annual IC Cost Burden (Dollars)	0	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.