OMB
.report
Search
Baseline Questionnaire for Children with Asthma
The Green Housing Study
OMB: 0920-0906
IC ID: 198570
OMB.report
HHS/CDC
OMB 0920-0906
ICR 201408-0920-008
IC 198570
( )
Documents and Forms
Document Name
Document Type
Form 0920-0906
Baseline Questionnaire for Children with Asthma
Form and Instruction
0920-0906 Appndx D5_Baseline_C7-12 5-10-2011
Appndx D5_Baseline_C7-12 5-10-2011.doc
Form and Instruction
Appendix D4 - Baseline (for Children 7-12 years) 5-10-11_CHN7.13.2011.doc
Baseline - children - Chinese
IC Document
Appendix D4 - Baseline (for Children 7-12 years) 5-10-11 SPANISH.docx
Baseline - children - Spanish
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Baseline Questionnaire for Children with Asthma
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
0920-0906
Appndx D5_Baseline_C7-12 5-10-2011
Appndx D5_Baseline_C7-12 5-10-2011.doc
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Immunization Management
Privacy Act System of Records
Title:
Epidemiological Studies and Surveillance of Disease Problems 0920-0136
FR Citation:
57 FR 62812
Number of Respondents:
832
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
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
Documents for IC
Title
Document
Date Uploaded
Baseline - children - Chinese
Appendix D4 - Baseline (for Children 7-12 years) 5-10-11_CHN7.13.2011.doc
12/14/2011
Baseline - children - Spanish
Appendix D4 - Baseline (for Children 7-12 years) 5-10-11 SPANISH.docx
12/14/2011
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.