Child Maltreatment Surveillance (Sample Web-based Assessment

Voluntary Product Satisfaction and Usability Assessment

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0847 can be found here:

Documents and Forms

Document Name Document Type
Attachment 5.pdf Other-Word

Information Collection (IC) Details

IC Title:	Child Maltreatment Surveillance (Sample Web-based Assessment	Agency IC Tracking Number:

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
Other-Word			Attachment 5.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 432,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	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	432,000	0	0	0	0	0
Annual IC Time Burden (Hours)	72,000	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	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.