Family Post-Visit Form – Refinement Phase

Assessing Strategies To Promote Children’s Engagement and Active Participation in Virtual Visits

Documents and Forms

Document Name Document Type
Form 7 Family Post-Visit Form – Refinement Phase Form and Instruction
7 Family Post-Visit Form – Refinement Phase Appendix K_Active Engagement_Instrument7.docx Form and Instruction
7 0906-0092 7_Family Post Visit Form-Refinement (Redline 0 0906-0092 7_Family Post Visit Form-Refinement.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Family Post-Visit Form – Refinement Phase	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	7	Family Post-Visit Form – Refinement Phase	Appendix K_Active Engagement_Instrument7.docx		Yes	Yes	Fillable Fileable
Form and Instruction	7	0906-0092 7_Family Post Visit Form-Refinement (Redline 07302024)	0906-0092 7_Family Post Visit Form-Refinement.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 48	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	288	288
Annual IC Time Burden (Hours)	23	23
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.