Follow-up survey (at birth)

Adolescent Family Life Care Program Core Evaluation

Documents and Forms

Document Name Document Type
Form 0990-0290 Follow-up survey (at birth) Form
0990-0290 Follow-up survey 0990-0290Appendix B_Draft Care Follow up_OMB_09-02-08_sbj_MK.doc Form

Information Collection (IC) Details

IC Title:	Follow-up survey (at birth)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	0990-0290	Follow-up survey	0990-0290Appendix B_Draft Care Follow up_OMB_09-02-08_sbj_MK.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13,000	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	13,000	13,000
Annual IC Time Burden (Hours)	4,983	4,983
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.