Enrollment Survey - mother

Prospective Birth Cohort Study Involving Environmental Uranium Exposure in the Navajo Nation

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0046 can be found here:

Documents and Forms

Document Name Document Type
Enrollment Survey - mother Form
Enrollement Survey for Mothers Attach 3a Mother Enroll 2-6-13.docx Form

Information Collection (IC) Details

IC Title:	Enrollment Survey - mother	Agency IC Tracking Number:	18768

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
Form	none	Enrollement Survey for Mothers	Attach 3a Mother Enroll 2-6-13.docx		No		Printable Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title: Records of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances	FR Citation: 57 FR 62812

Number of Respondents: 550	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	550	550
Annual IC Time Burden (Hours)	1,100	1,100
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.