OMB
.report
Search
FOLLOW-UP Survey of the Advisory Committee on Heritable Disorders in Newborns and Children's Public Health System Assessment
The Advisory Committee on Heritable Disorders in Newborns and Children's Public Health System Assessment Surveys
OMB: 0906-0014
IC ID: 215121
OMB.report
HHS/HRSA
OMB 0906-0014
ICR 202110-0906-003
IC 215121
( )
Documents and Forms
Document Name
Document Type
Form 2
FOLLOW-UP Survey of the Secretary's Advisory Committee on Heritable Disorders in Newborns and Children's Public Health System Assessment
Form and Instruction
FORM 2 FollowupSurvey_Tracked 6.4.2021.docx
Other-Tracked
FORM 2 FollowupSurvey_Tracked 6.4.2021.docx
Other-Tracked
2 Followup Survey_CLEAN.docx
FORM 2 Followup Survey_CLEAN.docx
Form and Instruction
2 Followup Survey_CLEAN.docx
FORM 2 Followup Survey_CLEAN.docx
Form and Instruction
Attachment E Screen Shot Survey Template.pdf
Attachment E - Screen Shot Survey Template
IC Document
Attachment E Screen Shot Survey Template.pdf
Attachment E - Screen Shot Survey Template
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
FOLLOW-UP Survey of the Advisory Committee on Heritable Disorders in Newborns and Children's Public Health System Assessment
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
Form and Instruction
2
Followup Survey_CLEAN.docx
FORM 2 Followup Survey_CLEAN.docx
Yes
Yes
Fillable Fileable
Other-Tracked
FORM 2 FollowupSurvey_Tracked 6.4.2021.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
30
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
60
0
0
0
0
60
Annual IC Time Burden (Hours)
120
0
0
0
0
120
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Attachment E - Screen Shot Survey Template
Attachment E Screen Shot Survey Template.pdf
08/27/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.