Information Collection

Clinic Visit- Control Parent

IC 178553 under ICR 200702-0920-001 · OMB 0920-0741.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0741 can be found here:

Documents and Forms

Document Name Document Type
Appendix F.4 Vineland.pdf Other-Vineland Adaptive Behavior Sca
Appendix E 3 Informed Consent Case 2007 06.doc Other-Written Informed Consent
Appendix E.3 Informed Consent NIC&Sub6-4-2007.doc Other-Written Informed Consent
Appendix Q Vineland Follow Up call.doc Administration of the Vineland in the Subcohort Telephone Script IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Clinic Visit- Control Parent	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Written Informed Consent	Appendix E 3 Informed Consent Case 2007 06.doc	Yes	Yes	Printable Only
Other-Written Informed Consent	Appendix E.3 Informed Consent NIC&Sub6-4-2007.doc	Yes	Yes	Printable Only
Other-Vineland Adaptive Behavior Scales	Appendix F.4 Vineland.pdf	Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 2,314	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,314	2,314
Annual IC Time Burden (Hours)	392	392
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Administration of the Vineland in the Subcohort Telephone Script	Appendix Q Vineland Follow Up call.doc	06/05/2007

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