Children Hopital of Los Angeles/Project AIM

Evaluation of Pregnancy Prevention Approaches - First Follow-up

Documents and Forms

Document Name Document Type
0990-0382Attachment C_CHLA.pdf Other-survey

Information Collection (IC) Details

IC Title:	Children Hopital of Los Angeles/Project AIM	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
Other-survey			0990-0382Attachment C_CHLA.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 254	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	Previously Approved
Annual Number of Responses for this IC	508	-398	906
Annual IC Time Burden (Hours)	305	-239	544
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.