MD Screening Tool

[NCBDDD] Focus Groups Among Adults with or Caring for Individuals with Congenital Heart Defects (CHD), Muscular Dystrophy (MD), and Spina Bifida (SB).

Documents and Forms

Document Name Document Type
MD Screening Tool Form and Instruction
MC Screening Tool Att12_MD5_Screening Tool_03222024.docx Form and Instruction
MC Screening Tool Att12_MD5_Screening Tool_03222024.docx Form and Instruction

Information Collection (IC) Details

IC Title:	MD Screening Tool	Agency IC Tracking Number:	0920-23DV

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	n/a	MC Screening Tool	Att12_MD5_Screening Tool_03222024.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 70	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	70	70
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	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.