Information Collection

Early Hearing Detecton and Intervention Hearing Screening and Follow-up survey

IC 43622 under ICR 201702-0920-015 · OMB 0920-0733.

Documents and Forms

Document Name Document Type
Early Hearing Detecton and Intervention Hearing Screening and Follow-up survey Form and Instruction
Screenshots for CDC EHDI Hearing Screening and Follow-up Attach_4C_2013_screenshots_Rev.pdf Form and Instruction
CDC EHDI Hearing Screening and Follow-up Survey (HSFS) Attach_4B_HSFS_2013.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Early Hearing Detecton and Intervention Hearing Screening and Follow-up survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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	None	Screenshots for CDC EHDI Hearing Screening and Follow-up Survey (HSFS)	Attach_4C_2013_screenshots_Rev.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	None	CDC EHDI Hearing Screening and Follow-up Survey (HSFS)	Attach_4B_HSFS_2013.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 55	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-55	55
Annual IC Time Burden (Hours)	-220	220
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.