Parent Component

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
RI_Parent Consent Form_FINAL_062907.doc Other-Parent Consent Form
RI_Parent Consent Form- Physio_FINAL_062907.doc Other-Parent Consent: Physio

Information Collection (IC) Details

IC Title:	Parent Component	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	OMB HtE RI Physiology_Appendix_1-10-07.doc	No	No	Paper Only
Other-Parent Consent Form	RI_Parent Consent Form_FINAL_062907.doc	No		Paper Only
Other-Parent Consent: Physio	RI_Parent Consent Form- Physio_FINAL_062907.doc	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,200	3,200
Annual IC Time Burden (Hours)	256	256
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.