Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Adult Cancer--Line 7 Modified 25000 7917 0 Form and Instruction 7 Adult Cancer--Line 7
Adult Core--line 3 Modified 25000 7083 0 Form and Instruction 3 Adult Core--line3
Adult Epilepsy--Line 10 New 25000 417 0 Form and Instruction 10 Adult Epilepsy--Line 10
Adult Occupational Injury--Line 9 Modified 25000 833 0 Form and Instruction 9 Chile Cancer--Line 8
Adult Quality of Life--Line 11 New 12500 1042 0 Form and Instruction 11 Adult Quality of Life--Line 11
Child Cancer--Line 8 Modified 10000 167 0 Form and Instruction 8 Child Cancer--Line 8
Child Core--line 4 Modified 10000 1500 0 Form and Instruction 4 Child Core--line 4
Child Mental Health--Line 14 New 10000 333 0 Form and Instruction 14 Child Mental Health--Line 14
Child Record Check--Line 12 New 1200 100 0 Form and Instruction 12 Child Record Check--Line 12
Child and Adult Immunization--Line 5 Modified 9400 627 0 Form and Instruction 5 Child and Adult Immunization--Line 5
Family Core - line 2 Modified 33000 12650 0 Form and Instruction 2 Family Core - line 2
Family Disability--Line 6 Modified 16500 825 0 Form and Instruction 6 Family Disability--Line 6
Reinterview Survey--Line 15 New 3000 250 0 Form and Instruction 15 Reinterview Survey--Line 15
Screener Questionnaire--Line 1 Modified 10000 833 0 Form and Instruction 1 OMB Statement and Screener Section of the
Teen Record Check--Line 13 New 4800 400 0 Form and Instruction 13 Teen Record Check--Line 13
Total burden requested under this ICR: 220400 34977 0  
To view an IC, click on IC Title