Child 4 - 8 Form

[NCBDDD] Documenting Outcomes Associated with Persistent Tic Disorders (Including Tourette Syndrome) in Children, Adolescents, and Young Adults Through Surveillance

Documents and Forms

Document Name Document Type
Child 4 - 8 Form Form and Instruction
Child 4 - 8 Att 7_Child 4-8 Forms.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Child 4 - 8 Form	Agency IC Tracking Number:	0920-24EG

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	Child 4 - 8	Att 7_Child 4-8 Forms.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 76 FR 4458

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	20	20
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.