Information Collection

SEED- Clinic Visit - Control Parent

IC 178553 under ICR 200709-0920-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form No number Appendix E.3 Informed Consent NIC & Sub SEED- Clinic Visit - Control Parent	Form and Instruction
Appendix F.4 Vineland SEED- Clinic Visit - Control Parent	Form and Instruction
Form No number Appendix E.3 Informed Consent Case SEED- Clinic Visit - Control Parent	Form and Instruction
Appendix F.3 Services and Treatment Q 2007 06.doc	Instruction
Appendix F.4 Vineland Appendix F.4 Vineland.pdf	Form and Instruction
No number Appendix E.3 Informed Consent Case Appendix E.3 Informed Consent Case 2007 06.doc	Form and Instruction
No number Appendix E.3 Informed Consent NIC & Sub Appendix E.3 Informed Consent NIC&Sub6-4-2007.doc	Form and Instruction

IC Title:

SEED- Clinic Visit - Control Parent

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	No number	Appendix E.3 Informed Consent NIC & Sub	Appendix E.3 Informed Consent NIC&Sub6-4-2007.doc	Yes	Yes	Fillable Printable
Form and Instruction	None	Appendix F.4 Vineland	Appendix F.4 Vineland.pdf	Yes	Yes	Printable Only
Instruction			Appendix F.3 Services and Treatment Q 2007 06.doc	Yes	Yes	Fillable Printable
Form and Instruction	No number	Appendix E.3 Informed Consent Case	Appendix E.3 Informed Consent Case 2007 06.doc	Yes	Yes	Fillable Printable

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	Previously Approved
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

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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