Appendix B: Summary Data Component Data Collection Form
Contact Information

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Administration for Children and Families
Administration on Children, Youth and Families
Children's Bureau

NATIONAL CHILD ABUSE AND NEGLECT DATA SYSTEM
Summary Data Component Survey
1998 Data Year
 
CONTACT INFORMATION

Submission Year:

State/Territory:

Reporting Year:

Begin Date:

End Date:

Contact Information

Name:

Title:

Unit/Office:

Department:

Address 1:

Address 2:

Phone:

FAX:

E-MAIL: