OMB
.report
Search
Att 4B_CDC EHDI Hearing Screening and Follow-up Survey (HSFS)
Early Hearing Detection and Intervention Hearing Screening and Follow-up survey
OMB: 0920-0733
IC ID: 226006
OMB.report
HHS/CDC
OMB 0920-0733
ICR 201702-0920-015
IC 226006
( )
Documents and Forms
Document Name
Document Type
Form CDC EHDI Hearing S
Att 4B_CDC EHDI Hearing Screening and Follow-up Survey (HSFS)
Form and Instruction
CDC EHDI Hearing S CDC
Att 4B_HSFS.docx
Form and Instruction
Att 7_Unclear Response Email_2016.docx
Att 7_Unclear Response Email
IC Document
Att 8_Invitation to Complete Survey_2016.docx
Att 8_Invitation
IC Document
Att 9_Survey Reminder Email_2016.docx
Att 9_Survey Reminder Email
IC Document
Att 10_Non Response Email_2016.docx
Att 10_Non-Response Email
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Att 4B_CDC EHDI Hearing Screening and Follow-up Survey (HSFS)
Agency IC Tracking Number:
0920-0733
Is this a Common Form?
No
IC Status:
New
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
CDC EHDI Hearing Screening and Follow-up Survey
CDC
Att 4B_HSFS.docx
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
57
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
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
57
0
57
0
0
0
Annual IC Time Burden (Hours)
228
0
228
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Att 7_Unclear Response Email
Att 7_Unclear Response Email_2016.docx
03/09/2017
Att 8_Invitation
Att 8_Invitation to Complete Survey_2016.docx
03/09/2017
Att 9_Survey Reminder Email
Att 9_Survey Reminder Email_2016.docx
03/09/2017
Att 10_Non-Response Email
Att 10_Non Response Email_2016.docx
03/09/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.