CHD Screening Tool

[NCBDDD] Focus Groups Among Adults with or Caring for Individuals with Congenital Heart Defects (CHD), Muscular Dystrophy (MD), and Spina Bifida (SB).

Documents and Forms

Document Name Document Type
CHD Screening Tool Form and Instruction
CHD Screening Tool Att3_CHD3_Screening Tool_03222024.docx Form and Instruction
CHD Screening Tool Att3_CHD3_Screening Tool_03222024.docx Form and Instruction

Information Collection (IC) Details

IC Title:	CHD Screening Tool	Agency IC Tracking Number:	0920-23DV

Is this a Common Form? No		IC Status: New

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 and Instruction	n/a	CHD Screening Tool	Att3_CHD3_Screening Tool_03222024.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 137	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	137	137
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	0	0

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.