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Key Informats (screening)
The Healthy Communities Study: How Communities Shape Childrens Health (NHLBI)
OMB: 0925-0649
IC ID: 199549
OMB.report
HHS/NIH
OMB 0925-0649
ICR 201307-0925-004
IC 199549
( )
Documents and Forms
Document Name
Document Type
Form 6
Key Informats (screening)
Form and Instruction
6 KI Screening Protocol Overview
FINAL_HCS_SSA_ATTACH 12_KI SCREENING_Jan 2013.docx
Form and Instruction
FINAL_HCS_SSA_ATTACH 11_KI BROCHURE_Jan 2013.docx
FINAL_HCS_SSA_ATTACH 11_KI BROCHURE_Jan 2013
IC Document
FINAL_HCS_SSA_ATTACH 10_KI LETTER_Jan 2013.docx
FINAL_HCS_SSA_ATTACH 10_KI LETTER_Jan 2013
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Key Informats (screening)
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
6
KI Screening Protocol Overview
FINAL_HCS_SSA_ATTACH 12_KI SCREENING_Jan 2013.docx
No
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:
3,520
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
3,520
0
0
1,913
0
1,607
Annual IC Time Burden (Hours)
293
0
0
164
0
129
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
FINAL_HCS_SSA_ATTACH 11_KI BROCHURE_Jan 2013
FINAL_HCS_SSA_ATTACH 11_KI BROCHURE_Jan 2013.docx
07/24/2013
FINAL_HCS_SSA_ATTACH 10_KI LETTER_Jan 2013
FINAL_HCS_SSA_ATTACH 10_KI LETTER_Jan 2013.docx
07/24/2013
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.