Parents/Caregivers (who refused)

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

Documents and Forms

Document Name Document Type
Form 4 Parents/Caregivers (who refused) Form and Instruction
4 Parents/Caregivers (who refuse) FINAL_HCS_SSA_ATTACH 8_PARENT REFUSAL PROTOCOL_Jan 2013.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Parents/Caregivers (who refused)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	4	Parents/Caregivers (who refuse)	FINAL_HCS_SSA_ATTACH 8_PARENT REFUSAL PROTOCOL_Jan 2013.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 880	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	880	77	803
Annual IC Time Burden (Hours)	147	10	137
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.