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INITIAL Survey of the Advisory Committee on Heritable Disorders in Newborns and Children's Public Health System Assessment
The Advisory Committee on Heritable Disorders in Newborns and Children's Public Health System Assessment Surveys
OMB: 0906-0014
IC ID: 215120
OMB.report
HHS/HRSA
OMB 0906-0014
ICR 202110-0906-003
IC 215120
( )
Documents and Forms
Document Name
Document Type
Form 1
INITIAL Survey of the Secretary's Discretionary Advisory Committee on Heritable Disorders in Newborns and Children's Public Health System Assessment
Form and Instruction
FORM 1 Initial Survey_TRACKED 6.4.2021.docx
Other-Tracked
FORM 1 Initial Survey_TRACKED 6.4.2021.docx
Other-Tracked
1 Initial Survey_CLEAN.docx
FORM 1 Initial Survey_CLEAN.docx
Form and Instruction
1 Initial Survey_CLEAN.docx
FORM 1 Initial Survey_CLEAN.docx
Form and Instruction
Attachment D Screenshot of Template for Intial Survey.pdf
Attachment D Screenshot of Template for Intial Survey
IC Document
Attachment D Screenshot of Template for Intial Survey.pdf
Attachment D Screenshot of Template for Intial Survey
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
INITIAL Survey of the Advisory Committee on Heritable Disorders in Newborns and Children's Public Health System Assessment
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
1
Initial Survey_CLEAN.docx
FORM 1 Initial Survey_CLEAN.docx
Yes
Yes
Fillable Fileable
Other-Tracked
FORM 1 Initial Survey_TRACKED 6.4.2021.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
59
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
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
118
0
0
0
0
118
Annual IC Time Burden (Hours)
1,180
0
0
0
0
1,180
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Attachment D Screenshot of Template for Intial Survey
Attachment D Screenshot of Template for Intial Survey.pdf
10/06/2021
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.