Information Collection

Child Screening Form

IC 245498 under ICR 202408-0920-007 · OMB 0920-1346.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Child Screening Form	Form and Instruction
Screening Form 2f_screening fields form.docx	Form and Instruction
Screening Form 2f_screening fields form.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-1346

Is this a Common Form? Yes

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Screening Form	2f_screening fields form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150,370

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 20 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	150,370	150,370
Annual IC Time Burden (Hours)	12,531	12,531
Annual IC Cost Burden (Dollars)	0	0

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.