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Mothes/Primary Caregivers of Enrolled Children Baseline Questionnaire - Demographics

IC 198569 under ICR 201408-0920-008 · OMB 0920-0906.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
IC Document
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Mothes/Primary Caregivers of Enrolled Children Baseline Questionnaire - Demographics
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0906 Appndx D4_Baseline Demog 6-29-2011 Appndx D4_Baseline Demog 6-29-2011.doc Yes Yes Fillable Fileable

Health Immunization Management

Epidemiological Studies and Surveillance of Disease Problems 0920-0136  57 FR 62812

832 0
   
Individuals or Households
 
   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 832 0 0 0 0 832
Annual IC Time Burden (Hours) 69 0 0 0 0 69
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Baseline - demographics - Chinese Appendix D3 - Baseline ( Demographics) 5-12-11_CHN8.18.2011.doc 12/14/2011
Baseline - demographics - Spanish Appendix D3 - Baseline ( Demographics) 5-12-11 SPANISH.docx 12/14/2011
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