Information Collection

Parent Report (for children ages 4-17)

IC 275090 under ICR 202504-0920-027 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Parent Report (for children ages 4-17)	Form and Instruction
Parent Form Parent Report (for children ages 4-17)	Form and Instruction
Parent Form Att 4_Parent forms.pdf	Form and Instruction
Parent Form Att_4 Parent forms.pdf	Form and Instruction
Att 9_Parent Forms in REDCap.pdf Parent Form Redcap copy	IC Document
Att 9_Parent Forms in REDCap.pdf Parent Form Redcap copy	IC Document

IC Title:

Agency IC Tracking Number:

0920-24EG

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	n/a				Yes	Yes	Fillable Fileable

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: 300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	225	225
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Parent Form Redcap copy		09/22/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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