Information Collection

SLAITS for 2009-2010 National Survey of Children with Special Health Care Needs

IC 188592 under ICR 200711-0920-007 · OMB 0920-0406.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0406 can be found here:

Documents and Forms

Document Name Document Type
SLAITS for 2009-2010 National Survey of Children with Special Health Care Needs Form
Survey questionnaire SLAITS 2009 NS-CSHCN survey Att 2 031109.doc Form
Screener for NS-CSHCN SLAITS 2009 NS-CSHCN survey Att 1 031109.doc Form
SLAITS 2009 NS-CSHCN Sup. St. 042709 Final.doc Supporting Statement IC Document
SLAITS 2009 NS-CSHCN Incentive Groups 042409 Final.pdf Incentive Memo IC Document
SLAITS 2009 NS-CSHCN survey Att 3 042709 FINAL.doc Participant Letters IC Document
SLAITS 2009 NS-CSHCN survey Att 4 030509.doc ERB Approval Notice IC Document
SLAITS 2009 NS-CSHCN survey Att 5 030509.doc Dress Rehersal Results IC Document
SLAITS 2009 NS-CSHCN survey Att 6 030509.doc Expret Consultants IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SLAITS for 2009-2010 National Survey of Children with Special Health Care Needs	Agency IC Tracking Number:

IC Status: New

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	Survey questionnaire	SLAITS 2009 NS-CSHCN survey Att 2 031109.doc		No	No	Fillable Fileable
Form	none	Screener for NS-CSHCN	SLAITS 2009 NS-CSHCN survey Att 1 031109.doc		No	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Health and Demographic Surveys Conducted in Probability Samples of the US Population	FR Citation: 49 FR 37637

Number of Respondents: 121,972	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	121,972	0	0	0	0	0
Annual IC Time Burden (Hours)	13,341	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	SLAITS 2009 NS-CSHCN Sup. St. 042709 Final.doc	04/28/2009
Incentive Memo	SLAITS 2009 NS-CSHCN Incentive Groups 042409 Final.pdf	04/28/2009
Participant Letters	SLAITS 2009 NS-CSHCN survey Att 3 042709 FINAL.doc	04/28/2009
ERB Approval Notice	SLAITS 2009 NS-CSHCN survey Att 4 030509.doc	04/28/2009
Dress Rehersal Results	SLAITS 2009 NS-CSHCN survey Att 5 030509.doc	04/28/2009
Expret Consultants	SLAITS 2009 NS-CSHCN survey Att 6 030509.doc	04/28/2009

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.