Parents/Caregivers

The Healthy Communities Study: How Communities Shape Childrens Health (NHLBI)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0649 can be found here:

Documents and Forms

Document Name Document Type
Form 2 Parents/Caregivers Form and Instruction
2 Family Household Visit Protocol Overview FINAL_HCS_SSA_ATTACH 6_PARENT PROTOCOL_Jan 2013 v2.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Parents/Caregivers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	2	Family Household Visit Protocol Overview	FINAL_HCS_SSA_ATTACH 6_PARENT PROTOCOL_Jan 2013 v2.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,128	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	7,128	-2,780	9,908
Annual IC Time Burden (Hours)	11,120	-175	11,295
Annual IC Cost Burden (Dollars)	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.