Young Child Componet

Rhode Island 15-Month Follow-UP Survey Amendment

Documents and Forms

Document Name Document Type
OMB HtE RI Physiology_Appendix_1-10-07.doc Instruction

Information Collection (IC) Details

IC Title:	Young Child Componet	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
Instruction			OMB HtE RI Physiology_Appendix_1-10-07.doc		No	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 160	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 82 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,280	-3,480	4,760
Annual IC Time Burden (Hours)	102	-2,871	2,973
Annual IC Cost Burden (Dollars)	0	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.