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

[NCBDDD] Population-based Surveillance of Outcomes, Needs, and Well-being of Children and Adolescents with Congenital Heart Defects

OMB: 0920-1382

IC ID: 254790

Documents and Forms
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Information Collection (IC) Details

View Information Collection (IC)

Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS
 
No Modified
 
Voluntary
 

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, paper) Att 4_Paper Survey English_May23.docx No   Paper Only
Form and Instruction None Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS (Spanish, paper) Att 5_Paper Survey Spanish_May23.docx No   Paper Only
Form and Instruction None Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS (Somali, paper) Att 23_Paper Survey Somali_May23.docx No   Paper Only
Form and Instruction None Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS (English, online) Att 24_Online Survey English_May23.docx Yes Yes Fillable Fileable
Form and Instruction None Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS (Spanish, online) Att 25_Online Survey Spanish_May23.docx Yes Yes Fillable Fileable
Form and Instruction None Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS (English, phone, MA) Att 32_MA Phone Script_May23.docx Yes Yes Fillable Fileable
Form and Instruction None Follow Up Question for Online Participants (English) Att 27_FollowUp Question English_May23.docx No   Paper Only
Form and Instruction None Follow Up Question for Online Participants (Spanish) Att 28_FollowUp Question Spanish_May23.docx No   Paper Only

Health Public Health Monitoring

09-20-0136, Epidemiologic Studies and Surveillance of Disease Problems  57 FR 62811

2,556 0
   
Individuals or Households
 
   0 %

  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 2,556 0 0 0 0 2,556
Annual IC Time Burden (Hours) 852 0 0 0 0 852
Annual IC Cost Burden (Dollars) 17,184 0 0 0 0 17,184

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