Information Collection

CH STRONG KIDS (Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS)

IC 254790 under ICR 202310-0920-008 · OMB 0920-1382.

⚠️ Notice: This information collection may be referencing outdated material.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

2025-03-28 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1382 CH STRONG KIDS (Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS)	Form and Instruction
0920-1382 CH STRONG KIDS (English, paper) Att 4_Paper Survey English_May23.docx	Form and Instruction
0920-1382 CH STRONG KIDS (English, paper) Att 4_Paper Survey English_May23.docx	Form and Instruction
0920-1382 Congenital Heart Survey To Recognize Outcomes, Needs, an Att 5_Paper Survey Spanish_Oct23.docx	Form and Instruction
0920-1382 Congenital Heart Survey To Recognize Outcomes, Needs, an Att 5_Paper Survey Spanish_Oct23.docx	Form and Instruction
0920-1382 CH STRONG KIDS (Congenital Heart Survey to Recognize Out Att 23_Paper Survey Somali_Oct23.docx	Form and Instruction
0920-1382 CH STRONG KIDS (Congenital Heart Survey to Recognize Out Att 23_Paper Survey Somali_Oct23.docx	Form and Instruction
0920-1382 CH STRONG KIDS (Congenital Heart Survey to Recognize Out Att 24_Online Survey English_Oct23.docx	Form and Instruction
0920-1382 CH STRONG KIDS (Congenital Heart Survey to Recognize Out Att 24_Online Survey English_Oct23.docx	Form and Instruction
0920-1382 CH STRONG KIDS (Congenital Heart Survey to Recognize Out Att 25_Online Survey Spanish_Oct23.docx	Form and Instruction
0920-1382 CH STRONG KIDS (Congenital Heart Survey to Recognize Out Att 25_Online Survey Spanish_Oct23.docx	Form and Instruction
Congenital Heart Survey To Recognize Outcomes, Needs, an Att 32_MA Phone Script_May23.docx	Form and Instruction
Congenital Heart Survey To Recognize Outcomes, Needs, an Att 32_MA Phone Script_May23.docx	Form and Instruction
Follow Up Question for Online Participants (English) Att 27_FollowUp Question English_May23.docx	Form and Instruction
Follow Up Question for Online Participants (English) Att 27_FollowUp Question English_May23.docx	Form and Instruction
Follow Up Question for Online Participants (Spanish) Att 28_FollowUp Question Spanish_May23.docx	Form and Instruction
Follow Up Question for Online Participants (Spanish) Att 28_FollowUp Question Spanish_May23.docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

CH STRONG KIDS (Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS)

Agency IC Tracking Number:

0920-1382-24AG

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1382	CH STRONG KIDS (English, paper)	Att 4_Paper Survey English_May23.docx	No		Paper Only
Form and Instruction	0920-1382	Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS (Spanish, paper)	Att 5_Paper Survey Spanish_Oct23.docx	No		Paper Only
Form and Instruction	0920-1382	CH STRONG KIDS (Congenital Heart Survey to Recognize Outcomes, Needs, and wellbeinG of KIDS)Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS (Somali, paper)	Att 23_Paper Survey Somali_Oct23.docx	No		Paper Only
Form and Instruction	0920-1382	CH STRONG KIDS (Congenital Heart Survey to Recognize Outcomes, Needs, and wellbeinG of KIDS)Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS (English, online)	Att 24_Online Survey English_Oct23.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1382	CH STRONG KIDS (Congenital Heart Survey to Recognize Outcomes, Needs, and wellbeinG of KIDS)Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS (Spanish, online)	Att 25_Online Survey Spanish_Oct23.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

Federal Enterprise Architecture Business Reference Module

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	Previously Approved
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.