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Federal forms, ICRs, and supporting documents

Information Collection

Att 4B_CDC EHDI Hearing Screening and Follow-up Survey (HSFS)

IC 226006 under ICR 201702-0920-015 · OMB 0920-0733.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

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Att 4B_CDC EHDI Hearing Screening and Follow-up Survey (HSFS) 0920-0733
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CDC EHDI Hearing Screening and Follow-up Survey CDC Att 4B_HSFS.docx Yes Yes Fillable Printable

Health Public Health Monitoring

 

57 0
   
State, Local, and Tribal Governments
 
   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 57 0 57 0 0 0
Annual IC Time Burden (Hours) 228 0 228 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att 7_Unclear Response Email Att 7_Unclear Response Email_2016.docx 03/09/2017
Att 8_Invitation Att 8_Invitation to Complete Survey_2016.docx 03/09/2017
Att 9_Survey Reminder Email Att 9_Survey Reminder Email_2016.docx 03/09/2017
Att 10_Non-Response Email Att 10_Non Response Email_2016.docx 03/09/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.