Information Collection

FOLLOW-UP Survey of the Advisory Committee on Heritable Disorders in Newborns and Children's Public Health System Assessment

IC 215121 under ICR 202110-0906-003 · OMB 0906-0014.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 FOLLOW-UP Survey of the Secretary's Advisory Committee on Heritable Disorders in Newborns and Children's Public Health System Assessment	Form and Instruction
FORM 2 FollowupSurvey_Tracked 6.4.2021.docx	Other-Tracked
FORM 2 FollowupSurvey_Tracked 6.4.2021.docx	Other-Tracked
2 Followup Survey_CLEAN.docx FORM 2 Followup Survey_CLEAN.docx	Form and Instruction
2 Followup Survey_CLEAN.docx FORM 2 Followup Survey_CLEAN.docx	Form and Instruction
Attachment E Screen Shot Survey Template.pdf Attachment E - Screen Shot Survey Template	IC Document
Attachment E Screen Shot Survey Template.pdf Attachment E - Screen Shot Survey Template	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	2	Followup Survey_CLEAN.docx	FORM 2 Followup Survey_CLEAN.docx		Yes	Yes	Fillable Fileable
Other-Tracked			FORM 2 FollowupSurvey_Tracked 6.4.2021.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	120	120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment E - Screen Shot Survey Template	Attachment E Screen Shot Survey Template.pdf	08/27/2018

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