OMB.report

Federal forms, ICRs, and supporting documents

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 NameDocument 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.pdf 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)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Yes Yes Fillable Printable
Other-WORD Yes Yes Fillable Printable
Other-WORD Yes Yes Fillable Printable
Other-word Yes Yes Fillable Printable
Other-WORD Yes Yes Fillable Printable
Other-word Yes Yes Fillable Printable
Other-WORD Yes Yes Fillable Printable
Other-word Yes Yes Fillable Printable
Other-WORD Yes Yes Fillable Printable
Other-WORD Yes Yes Fillable Printable
Other-WORD Yes Yes Fillable Printable
Other-WORD Yes Yes Fillable Printable
Other-WORD Yes Yes Fillable Printable
Other-WORD Yes Yes Fillable Printable
Other-WORD Yes Yes Fillable Printable
Other-WORD Yes Yes Fillable Printable
Other-WORD Yes Yes Fillable Printable
Other-WORD Yes Yes Fillable Printable
Other-WORD Yes Yes Fillable Printable
Other-word Yes Yes Fillable Printable
Other-word Yes Yes Fillable Printable
Other-WORD Yes Yes Fillable Printable
Other-WORD Yes Yes Fillable Printable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 347 0 -44,581 0 0 44,928
Annual IC Time Burden (Hours) 1,215 0 -11,169 0 0 12,384
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Appendix_E 04/13/2010
Appendix_E 04/13/2010
Appendix_E 04/13/2010
Appendix_E 04/13/2010
Appendix_E 04/13/2010
Appendix_E 04/13/2010
Appendix_E 04/15/2010
Appendix_E 04/15/2010
Appendix_E 04/15/2010
Appendix_E 04/15/2010
Appendix_E 04/15/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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