|
CH STRONG KIDS (Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS) |
|
0920-1382-24AG |
| |
|
No
|
Modified |
| |
|
Voluntary
|
| |
|
|
| Document Type |
Form No. |
Form Name |
Instrument File |
URL |
Available Electronically? |
Can Be Submitted Electronically? |
Electronic Capability |
| Form and Instruction |
0920-1382 |
CH STRONG KIDS (English, paper)
|
Att 4_Paper Survey English_May23.docx
|
|
No |
|
Paper Only |
| Form and Instruction |
0920-1382 |
Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS (Spanish, paper)
|
Att 5_Paper Survey Spanish_Oct23.docx
|
|
No |
|
Paper Only |
| Form and Instruction |
0920-1382 |
CH STRONG KIDS (Congenital Heart Survey to Recognize Outcomes, Needs, and wellbeinG of KIDS)Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS (Somali, paper)
|
Att 23_Paper Survey Somali_Oct23.docx
|
|
No |
|
Paper Only |
| Form and Instruction |
0920-1382 |
CH STRONG KIDS (Congenital Heart Survey to Recognize Outcomes, Needs, and wellbeinG of KIDS)Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS (English, online)
|
Att 24_Online Survey English_Oct23.docx
|
|
Yes |
Yes |
Fillable Fileable |
| Form and Instruction |
0920-1382 |
CH STRONG KIDS (Congenital Heart Survey to Recognize Outcomes, Needs, and wellbeinG of KIDS)Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS (Spanish, online)
|
Att 25_Online Survey Spanish_Oct23.docx
|
|
Yes |
Yes |
Fillable Fileable |
| Form and Instruction |
None |
Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS (English, phone, MA)
|
Att 32_MA Phone Script_May23.docx
|
|
Yes |
Yes |
Fillable Fileable |
| Form and Instruction |
None |
Follow Up Question for Online Participants (English)
|
Att 27_FollowUp Question English_May23.docx
|
|
No |
|
Paper Only |
| Form and Instruction |
None |
Follow Up Question for Online Participants (Spanish)
|
Att 28_FollowUp Question Spanish_May23.docx
|
|
No |
|
Paper Only |
|
Health
|
Public Health Monitoring
|
|
|
|
09-20-0136, Epidemiologic Studies and Surveillance of Disease Problems
|
57 FR 62811
|
|
2,556
|
0
|
| |
|
|
Individuals or Households
|
|
| |
|
0
%
|
| |
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 |
2,556 |
0 |
0 |
0 |
0 |
2,556 |
| Annual IC Time Burden (Hours) |
852 |
0 |
0 |
0 |
0 |
852 |
| Annual IC Cost Burden (Dollars) |
17,184 |
0 |
0 |
0 |
0 |
17,184 |
| Title |
Document |
Date Uploaded |
| No associated records found |
|
