MUH Resident Baseline Survey - Children's Module LA

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

OMB: 0920-1004

IC ID: 204444

Information Collection (IC) Details

View Information Collection (IC)

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

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none MUH Resident Baseline - Children's Module section G clean 12.17.13Att 8A(e)_MUH Resident Baseline Survey.doc Yes No Fillable Printable
Form none MUH Resident Baseline - Children's Module section G Spanish clean 12.17.13 Att 8A(s)_MUH Resident Baseline Survey_12.15.13.doc Yes No Fillable Printable

Health Immunization Management

 

250 0
   
Individuals or Households
 
   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 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
Consent Adult clean 12.17.13 Att 8A-1(e) MUH Resident Adult Participant Consent_9.3.......docx 12/19/2013
Consent Adult Spanish clean 12 17. 13 Att 8A-1(s) MUH Resident Adult Participant Consent_9 3 1....docx 12/19/2013
IRB Authorization Att 8A-2(e) MUHAdult Resident HIPPA form_9.3.13.docx 09/23/2013
IRB Authoization Spanish Att 8A-2(s) MUHAdult Resident HIPPA form 9.3.13.docx 09/23/2013
Consent Child clean 12.17.13 Att 8A-3(e) LA Resident Consent for Child Questions_9.3......docx 12/19/2013
Consent Child Spanish clean 12 17 13 Att 8A-3(s) LA Resident Consent for Child Questions_9 3 1....docx 12/19/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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