SDY Module - State Health Personnel

Sudden Death in the Young Registry

Documents and Forms

Document Name Document Type
SDY Module - State Health Personnel Form
NCFRP Cases Reporting System SDY Module 1 Att 2a_NFR-CRS-SDY Module I.pdf Form
NCFRP Cases Reporting System SDY Module 1 Att 2a_NFR-CRS-SDY Module I.pdf Form

Information Collection (IC) Details

IC Title:	SDY Module - State Health Personnel	Agency IC Tracking Number:	0920-1092

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	none	NCFRP Cases Reporting System SDY Module 1	Att 2a_NFR-CRS-SDY Module I.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13	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 Agency Discretion	Previously Approved
Annual Number of Responses for this IC	715	-27	742
Annual IC Time Burden (Hours)	119	-5	124
Annual IC Cost Burden (Dollars)	2,252	-85	2,337

Documents for IC

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.