Information Collection Request

The Study to Explore Early Development (SEED)

ICR 201005-0920-003 · OMB 0920-0741 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form No number SEED - Follow-Up Telephone Calls Form and Instruction Modified Available
_SEED_Supp_Statement_B.doc Supporting Statement B Uploaded 2010-04-12 Available
Appendix_Y_Participant_Newsletter_example.pdf Supplementary Document Uploaded 2010-04-15 Available
Appendix_X_Confidentiality_Agreement.doc Supplementary Document Uploaded 2010-04-15 Available
Appendix_W7_Certificate_Confidentiality_PA_Univ_PA.pdf Supplementary Document Uploaded 2010-04-15 Available
Appendix_W6_Certificate_Confidentiality_MD_JHU.pdf Supplementary Document Uploaded 2010-04-15 Available
Appendix_W5_Certificate_Confidentiality_NC.pdf Supplementary Document Uploaded 2010-04-15 Available
Appendix_W4_Certificate_Confidentiality_CO.pdf Supplementary Document Uploaded 2010-04-15 Available
Appendix_W3_Certificate_Confidentiality_CA.pdf Supplementary Document Uploaded 2010-04-15 Available
Appendix_W2_Certificate_Confidentiality_GA_RTI.pdf Supplementary Document Uploaded 2010-04-15 Available
Appendix_W1_Certificate_Confidentiality_GA_Batelle.pdf Supplementary Document Uploaded 2010-04-15 Available
Appendix_V_ListofRequestedChangestoICR_3_31_Clean.doc Supplementary Document Uploaded 2010-04-15 Available
Appendix_U _DataSharingApprovalProcess_DC_3_30_2010.doc Supplementary Document Uploaded 2010-04-15 Available
Appendix_T Hypotheses.doc Supplementary Document Uploaded 2010-04-15 Available
Appendix_Q Study Start Vineland Phone script 2007.doc Supplementary Document Uploaded 2010-04-15 Available
Appendix_L. ICD DSM Code List.doc Supplementary Document Uploaded 2010-04-15 Available
Appendix_K. SEED Acsertainment methodology.doc Supplementary Document Uploaded 2010-04-15 Available
Appendix_I CDC IRB Approval.pdf Supplementary Document Uploaded 2010-04-15 Available
Appendix_D.4 Research Domains by DC Activity.doc Supplementary Document Uploaded 2010-04-15 Available
Appendix_D.3 DC Instrument Summary Table.doc Supplementary Document Uploaded 2010-04-15 Available
Appendix_D.1 Study Data Collection Flow.pdf Supplementary Document Uploaded 2010-04-15 Available
Appendix_B.1 60dy FRN.pdf Supplementary Document Uploaded 2010-04-15 Available
Appendix_A_Authorizing Legislation.pdf Supplementary Document Uploaded 2010-04-15 Available
Appendix_Z_Detailed_Breakdown_BurdenHOURSand COSTS_margins_ok.docx Supplementary Document Uploaded 2010-05-03 Available
Appendix_R.1 Biosample Shipping, Processing & Storage.doc Supplementary Document Uploaded 2010-04-27 Available
Appendix_M.2_SEED ThankYouLetter 2007.doc Supplementary Document Uploaded 2010-04-14 Repair queued
Appendix_M.3_SEED Parent feedback letter 17Aug09.doc Supplementary Document Uploaded 2010-04-14 Available
Appendix_M.1_SEEDPassive refusal letter 2007.doc Supplementary Document Uploaded 2010-04-14 Available
Appendix_E.7 Study Start Frequently Asked Questions on Biosampling 2007 .doc Supplementary Document Uploaded 2010-04-26 Available
Appendix_R.1 Biosample Shipping, Processing & Storage.doc Supplementary Document Uploaded 2010-04-15 Available
Appendix_E.19 Study Start How to collect Cheek Swab 2007.doc Supplementary Document Uploaded 2010-04-15 Available
Appendix P.1_ Dysmorphology Protocol.doc Supplementary Document Uploaded 2010-04-27 Available
Appendix_P.1 Study Start Child Control Clinic Visit Coversheet 2007.doc Supplementary Document Uploaded 2010-04-26 Available
Appendix_E.3 Study Start Informed Consent NIC- Sub 2007.doc Supplementary Document Uploaded 2010-04-26 Available
Appendix_S.5 PEDIATRIC FORM 3.6.09 FINAL.DOC Supplementary Document Uploaded 2010-04-27 Source copy available
Appendix_S.4 NEONATAL FORM FINAL.DOC Supplementary Document Uploaded 2010-04-27 Available
Appendix_S.3 Labor and Delivery MR Form Final.doc Supplementary Document Uploaded 2010-04-27 Available
Appendix_S.2 Prenatal MR Form FINAL STUDY START VERSION.doc Supplementary Document Uploaded 2010-04-27 Available
Appendix_E.19 Study Start How to collect Cheek Swab 2007.doc Supplementary Document Uploaded 2010-04-15 Available
Appendix_E.16.1 Study Start Child Sleep Habits Questionnaires Coversheet 2007.doc Supplementary Document Uploaded 2010-04-15 Repair queued
Appendix_E.8 Study Start Rights of Research Subjects.doc Supplementary Document Uploaded 2010-04-15 Available
Appendix_E.7 Study Start Frequently Asked Questions on Biosampling 2007 .doc Supplementary Document Uploaded 2010-04-15 Available
Appendix_E.6 Study Start Medical Glossary 2007.doc Supplementary Document Uploaded 2010-04-15 Available
Appendix_E.18.2 Study start medical records release cover sheets.doc Supplementary Document Uploaded 2010-04-13 Available
Appendix_E.18.1 Study Start HIPAA letter providerwksht 2007.doc Supplementary Document Uploaded 2010-04-13 Available
Appendix_E.17.3 Study Start Social Responsiveness Scale-preschool coversheet 2007.doc Supplementary Document Uploaded 2010-04-13 Available
Appendix_E.17.2 Study Start Social Responsiveness Scale adult coversheet 2007.doc Supplementary Document Uploaded 2010-04-13 Available
Appendix_E.17.1 Study Start Social Responsiveness Scale-child coversheet 2007.doc Supplementary Document Uploaded 2010-04-13 Repair queued
Appendix_E.10.1 Study Start Carey Questionnaires Coversheet 2007.doc Supplementary Document Uploaded 2010-04-13 Repair queued
Appendix_J Social Communication Questionnaire Coversheet.pdf Supplementary Document Uploaded 2010-04-15 Available
Appendix_M.2_SEED ThankYouLetter 2007.doc Supplementary Document Uploaded 2010-04-14 Available
Appendix_M.3_SEED Parent feedback letter 17Aug09.doc Supplementary Document Uploaded 2010-04-14 Available
Appendix_M.1_SEEDPassive refusal letter 2007.doc Supplementary Document Uploaded 2010-04-14 Available
_SEED_Sup St_A_042110.doc Supporting Statement A Uploaded 2010-05-03 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
192885 SEED_ Informed Consent Forms for Control Parents Other-WORD New
192884 SEED Blood Draw Other-WORD New
180497 SEED - Follow-Up Telephone Calls Form and Instruction Modified
178556 SEED - Biosamples (cheek swab and blood) Other-WORD Modified
178555 SEED - Clinic Visit- Case Child Other-WORD Modified
178554 SEED - Clinic Visit -Control Children Other-WORD Modified
178553 SEED- Clinic Visit - Control Parent Other-WORD Modified
178552 SEED - Clinic Visit- Case Parent Other-WORD Modified
178551 SEED- Care Giver Interview Other-word Modified
178550 SEED - Medical Record Abstraction Other-WORD Modified
178540 SEED - Questionaire Packets Other-WORD Modified
178539 SEED - Invitation (Telephone Call) Packet Other-WORD Modified
178538 SEED - Mailed Invitation Packet (Response Card) Other-WORD Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2013 36 Months From Approved 07/31/2010
9,720 0 146,278
4,948 0 50,448
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 9,720 146,278 0 -136,558 0 0
Annual Time Burden (Hours) 4,948 50,448 0 -45,500 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No