Information Collection

Clinic Visit - Case Child

IC 178555 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Appendix G.1 ADOS.pdf	Other-ADOS
Appendix G.2 Mullen.pdf	Other-Mullen Scales of Early Learnin
appendix P Dysmorphology Exam.doc	Other-Dysmorphology Exam Data Collec
appendix P Dysmorphology Exam.doc Dysmorphology Exam Protocol	IC Document

IC Title:

Clinic Visit - Case Child

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Mullen Scales of Early Learning	Appendix G.2 Mullen.pdf	Yes	Yes	Printable Only
Other-ADOS	Appendix G.1 ADOS.pdf	Yes	Yes	Printable Only
Other-Dysmorphology Exam Data Collection Form	appendix P Dysmorphology Exam.doc	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: 810

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,430	2,430
Annual IC Time Burden (Hours)	1,351	1,351
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Dysmorphology Exam Protocol	appendix P Dysmorphology Exam.doc	06/05/2007

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