MUH Resident Baseline Survey - Children's Module - LA County

Adoption, Health Impact and Cost of Smoke-Free Multi-Unit Housing Policies

OMB: 0920-1004

IC ID: 204442

Information Collection (IC) Details

View Information Collection (IC)

MUH Resident Baseline Survey - Children's Module - LA County
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Resident Survey - Children's Module - LA County -English Att 8A(e)_MUH Resident Baseline Survey_8 30 2012.doc No No Paper Only
Form none Resident Survey - Children's Module -LA County - Spanish Att 8A(s)_MUH Resident Baseline Survey_8 30 2012.doc No No Paper Only

Health Immunization Management

 

250 0
   
Individuals or Households
 
   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 250 0 250 0 0 0
Annual IC Time Burden (Hours) 63 0 63 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Adult Consent - English Att 8A-1(e)_MUH Resident Adult Consent.docx 09/27/2012
Adult Consent- Spanish Att 8A-1(s)_MUH Resident Adult Consent_8 30 2012.docx 09/27/2012
LA HIPPA - English Att 8A-2(e)_LA HIPPA Form.docx 09/27/2012
LA HIPPA - Spanish Att 8A-2(s)_LA HIPPA Form_8 30 2012.docx 09/27/2012
Child Consent - English Att 8A-3(e)_LA Resident Consent for Child Questions.docx 09/27/2012
Child Consent - Spanish Att 8A-3(s)_LA Resident Consent for Child Questions_8 30 2012.docx 09/27/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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