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Post-Implementation Survey for Parents
Evaluating Reach, Awareness, and Exposure of Enhanced Implementation of the Learn the Signs. Act Early. Campaign in Four Target Sites
OMB: 0920-0911
IC ID: 200249
OMB.report
HHS/CDC
OMB 0920-0911
ICR 201111-0920-006
IC 200249
( )
Documents and Forms
Document Name
Document Type
Form 6
Post-Implementation Survey for Parents
Form and Instruction
6 A Post-Implementaion Survey for Parents-Spanish
Att 3F Post-implementation Survey for Parents (Spanish) 9 9 11.docx
Form and Instruction
5 A Post-Implementation Survey for Parents-English
Att 3E Post-implementation Survey for Parents (English) 9 9 11.docx
Form and Instruction
3E LTSAE ATT3E Post-Implementation Survey for Parents (Engl
LTSAE att3E Post-implementation Survey for Parents (English) OMB Rev.doc
Form and Instruction
3F LTSAE ATT3F Post-Implementation Survey for Parents (Span
LTSAE att3F Post-implementation Survey for Parents (Spanish) OMB Rev.doc
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Post-Implementation Survey for Parents
Agency IC Tracking Number:
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
6
A Post-Implementaion Survey for Parents-Spanish
Att 3F Post-implementation Survey for Parents (Spanish) 9 9 11.docx
Yes
No
Paper Only
Form and Instruction
5
A Post-Implementation Survey for Parents-English
Att 3E Post-implementation Survey for Parents (English) 9 9 11.docx
Yes
No
Paper Only
Form and Instruction
3F
LTSAE ATT3F Post-Implementation Survey for Parents (Spanish) OMB
LTSAE att3F Post-implementation Survey for Parents (Spanish) OMB Rev.doc
Yes
No
Paper Only
Form and Instruction
3E
LTSAE ATT3E Post-Implementation Survey for Parents (English) OMB
LTSAE att3E Post-implementation Survey for Parents (English) OMB Rev.doc
Yes
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
1,000
0
1,000
0
0
0
Annual IC Time Burden (Hours)
167
0
167
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.