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ACBS Consent and Survey - Child
[NCEH] Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey (ACBS)
OMB: 0920-1204
IC ID: 224744
OMB.report
HHS/CDC
OMB 0920-1204
ICR 202306-0920-014
IC 224744
( )
Documents and Forms
Document Name
Document Type
ACBS Consent and Survey - Child
Form and Instruction
ACBS Child Consent and Questionnaire
Att5f ACBS Child CnsntQstnnr 2023 Rev.docx
Form and Instruction
ACBS Child Consent and Questionnaire
Att5f ACBS Child CnsntQstnnr 2023 Rev.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
ACBS Consent and Survey - Child
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
None
ACBS Child Consent and Questionnaire
Att5f ACBS Child CnsntQstnnr 2023 Rev.docx
Yes
Yes
Fillable Fileable
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:
3,764
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
3,764
0
-23
0
0
3,787
Annual IC Time Burden (Hours)
627
0
-4
0
0
631
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.