Information Collection

Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS

IC 254790 under ICR 202206-0920-002 · OMB 0920-1382.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1382 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS	Form and Instruction
Congenital Heart Survey To Recognize Outcomes, Needs, an Att 4_Survey English_07132022.docx	Form and Instruction
Congenital Heart Survey To Recognize Outcomes, Needs, an Att 4_Survey English_07132022.docx	Form and Instruction
Congenital Heart Survey To Recognize Outcomes, Needs, an Att 5_Survey Spanish.docx	Form and Instruction
Congenital Heart Survey To Recognize Outcomes, Needs, an Att 5_Survey Spanish.docx	Form and Instruction

IC Title:

Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS

Agency IC Tracking Number:

Is this a Common Form? No

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	None	Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS (English)	Att 4_Survey English_07132022.docx		No		Paper Only
Form and Instruction	None	Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS (Spanish)	Att 5_Survey Spanish.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0136, Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62811

Number of Respondents: 2,556

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,556	2,556
Annual IC Time Burden (Hours)	852	852
Annual IC Cost Burden (Dollars)	17,184	17,184

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.