Information Collection

SEED - Questionaire Packets

IC 178540 under ICR 201005-0920-003 · OMB 0920-0741.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix_E.1 Study Start Enrollment Packet Cover letter NIC-Subcohort 2007.doc	Other-WORD
Appendix_E.1 Study Start Enrollment Packet Cover letters CASE 2007.doc	Other-WORD
Appendix_E.2 Study Start Yellow FolderInstr 2007.doc	Other-WORD
Appendix_E.2.3 Study Start Subcohort- NIC Questionnaire Checklist.doc	Other-word
Appendix_E.2.2 Study Start Green Folder Instr 2007.doc	Other-WORD
Appendix_E.4 Study Start Clinic Visit Prep Guide 2007 NIC- SUBCOHORT 2007.doc	Other-word
Appendix_E.4 Study Start Clinic Visit Prep Guide CASE 2007.doc	Other-WORD
Appendix_E.2.1 Study Start Blue FolderInstr 2007.doc	Other-word
Appendix_E.5 Study Start Caregiver Prep Guide 2007.doc	Other-WORD
Appendix_E.9 Study Start Autoimmune Survey 2007.doc	Other-WORD
Appendix_E.10 Carey Temperament Scales.pdf	Other-WORD
Appendix_E.11 CBCL.pdf	Other-WORD
Appendix_E.12 Study Start GI Questionnaire 2007.doc	Other-WORD
Appendix_E.13 Study Start Maternal Med-HX 12-2007.doc	Other-WORD
Appendix_E.14 Study Start Paternal MedHX 12-2007.doc	Other-WORD
Appendix_E.15 Study Start Paternal Occup History 02- 17-09.doc	Other-WORD
Appendix_E.16 Child Sleep Habits Q.pdf	Other-WORD
Appendix_E.17 SRS-adult version.pdf	Other-WORD
Appendix_E.17 SRS-child version.doc	Other-WORD
Appendix_E.17 Study Start Social Responsiveness Scale-preschool. pdf..pdf	Other-word
Appendix_E.18 Study Start HIPPA Provider checklist & med records release 2007.doc	Other-word
Appendix_H.1_3_day_diet_diary.doc	Other-WORD
Appendix_H.2 Study Start Seven day Stool diary 2007.doc	Other-WORD
Appendix_E.10.1 Study Start Carey Questionnaires Coversheet 2007.doc Appendix_E	IC Document
Appendix_E.17.1 Study Start Social Responsiveness Scale-child coversheet 2007.doc Appendix_E	IC Document
Appendix_E.17.2 Study Start Social Responsiveness Scale adult coversheet 2007.doc Appendix_E	IC Document
Appendix_E.17.3 Study Start Social Responsiveness Scale-preschool coversheet 2007.doc Appendix_E	IC Document
Appendix_E.18.1 Study Start HIPAA letter providerwksht 2007.doc Appendix_E	IC Document
Appendix_E.18.2 Study start medical records release cover sheets.doc Appendix_E	IC Document
Appendix_E.6 Study Start Medical Glossary 2007.doc Appendix_E	IC Document
Appendix_E.7 Study Start Frequently Asked Questions on Biosampling 2007 .doc Appendix_E	IC Document
Appendix_E.8 Study Start Rights of Research Subjects.doc Appendix_E	IC Document
Appendix_E.16.1 Study Start Child Sleep Habits Questionnaires Coversheet 2007.doc Appendix_E	IC Document
Appendix_E.19 Study Start How to collect Cheek Swab 2007.doc Appendix_E	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

SEED - Questionaire Packets

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD	Appendix_E.1 Study Start Enrollment Packet Cover letter NIC-Subcohort 2007.doc	Yes	Yes	Fillable Printable
Other-WORD	Appendix_E.1 Study Start Enrollment Packet Cover letters CASE 2007.doc	Yes	Yes	Fillable Printable
Other-WORD	Appendix_E.2 Study Start Yellow FolderInstr 2007.doc	Yes	Yes	Fillable Printable
Other-word	Appendix_E.2.3 Study Start Subcohort- NIC Questionnaire Checklist.doc	Yes	Yes	Fillable Printable
Other-WORD	Appendix_E.14 Study Start Paternal MedHX 12-2007.doc	Yes	Yes	Fillable Printable
Other-WORD	Appendix_E.2.2 Study Start Green Folder Instr 2007.doc	Yes	Yes	Fillable Printable
Other-word	Appendix_E.4 Study Start Clinic Visit Prep Guide 2007 NIC- SUBCOHORT 2007.doc	Yes	Yes	Fillable Printable
Other-WORD	Appendix_E.4 Study Start Clinic Visit Prep Guide CASE 2007.doc	Yes	Yes	Fillable Printable
Other-word	Appendix_E.2.1 Study Start Blue FolderInstr 2007.doc	Yes	Yes	Fillable Printable
Other-WORD	Appendix_E.5 Study Start Caregiver Prep Guide 2007.doc	Yes	Yes	Fillable Printable
Other-WORD	Appendix_E.9 Study Start Autoimmune Survey 2007.doc	Yes	Yes	Fillable Printable
Other-WORD	Appendix_E.10 Carey Temperament Scales.pdf	Yes	Yes	Fillable Printable
Other-WORD	Appendix_E.11 CBCL.pdf	Yes	Yes	Fillable Printable
Other-WORD	Appendix_E.12 Study Start GI Questionnaire 2007.doc	Yes	Yes	Fillable Printable
Other-WORD	Appendix_E.13 Study Start Maternal Med-HX 12-2007.doc	Yes	Yes	Fillable Printable
Other-WORD	Appendix_E.15 Study Start Paternal Occup History 02- 17-09.doc	Yes	Yes	Fillable Printable
Other-WORD	Appendix_E.16 Child Sleep Habits Q.pdf	Yes	Yes	Fillable Printable
Other-WORD	Appendix_E.17 SRS-adult version.pdf	Yes	Yes	Fillable Printable
Other-WORD	Appendix_E.17 SRS-child version.doc	Yes	Yes	Fillable Printable
Other-word	Appendix_E.17 Study Start Social Responsiveness Scale-preschool. pdf..pdf	Yes	Yes	Fillable Printable
Other-word	Appendix_E.18 Study Start HIPPA Provider checklist & med records release 2007.doc	Yes	Yes	Fillable Printable
Other-WORD	Appendix_H.1_3_day_diet_diary.doc	Yes	Yes	Fillable Printable
Other-WORD	Appendix_H.2 Study Start Seven day Stool diary 2007.doc	Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

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: 347

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	Previously Approved
Annual Number of Responses for this IC	347	-44,581	44,928
Annual IC Time Burden (Hours)	1,215	-11,169	12,384
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix_E	Appendix_E.10.1 Study Start Carey Questionnaires Coversheet 2007.doc	04/13/2010
Appendix_E	Appendix_E.17.1 Study Start Social Responsiveness Scale-child coversheet 2007.doc	04/13/2010
Appendix_E	Appendix_E.17.2 Study Start Social Responsiveness Scale adult coversheet 2007.doc	04/13/2010
Appendix_E	Appendix_E.17.3 Study Start Social Responsiveness Scale-preschool coversheet 2007.doc	04/13/2010
Appendix_E	Appendix_E.18.1 Study Start HIPAA letter providerwksht 2007.doc	04/13/2010
Appendix_E	Appendix_E.18.2 Study start medical records release cover sheets.doc	04/13/2010
Appendix_E	Appendix_E.6 Study Start Medical Glossary 2007.doc	04/15/2010
Appendix_E	Appendix_E.7 Study Start Frequently Asked Questions on Biosampling 2007 .doc	04/15/2010
Appendix_E	Appendix_E.8 Study Start Rights of Research Subjects.doc	04/15/2010
Appendix_E	Appendix_E.16.1 Study Start Child Sleep Habits Questionnaires Coversheet 2007.doc	04/15/2010
Appendix_E	Appendix_E.19 Study Start How to collect Cheek Swab 2007.doc	04/15/2010

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