Form Approved
OMB NO. 0920-0741
Exp. Date 6/30/2010
Response Card
Front:
Study to Explore Early Development (SEED)
Back:
SEED STUDY:
____I would like to learn more about this project
____I am NOT interested in learning more about this project
Name:________________________
I can be reached at:
(address)_______________________
_______________________________
(telephone) ____________
(email)___________
I prefer to be reached by (circle one):
Telephone Mail E-mail
Best time to reach me is (circle one):
Morning Afternoon Early Evening
Study ID:__________
Public Reporting Burden
Statement
Public reporting burden of
this collection of information is estimated to average 10 minutes
per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information.
An agency may not conduct or sponsor, and a person is not required
to respond to a collection of information unless it displays a
currently valid OMB control number. Send comments regarding this
burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden to
CDC/ATSDR Reports
Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia
30333; ATTN: PRA (0920-0741)
Created
on
| File Type | application/msword |
| Author | zhv7 |
| Last Modified By | zhv7 |
| File Modified | 2007-09-25 |
| File Created | 2007-09-25 |