Mothers/Primary Caregivers of Enrolled Children Baseline Questionnaire(Home Characteristics)

The Green Housing Study

OMB: 0920-0906

IC ID: 198567

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Mothers/Primary Caregivers of Enrolled Children Baseline Questionnaire(Home Characteristics)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0906 Appndx_D2_Baseline_HomeChar Appndx_D2_Baseline_HomeChar (10-20-11).doc Yes Yes Fillable Fileable

Health Immunization Management

Epidemiological Studies and Surveillance of Disease Problems 09-20-0136  57 FR 62812

832 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 832 0 0 0 0 832
Annual IC Time Burden (Hours) 208 0 0 0 0 208
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Baseline - home characteristics - Chinese Baseline (Home Characteristics) Chinese version - November 30, 2011.doc 12/14/2011
Baseline - home characteristics - Spanish Baseline (Home Characteristics) SPANISH - November 30, 2011.doc 12/14/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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