Information Collection

SEED - Clinic Visit- Case Parent

IC 178552 under ICR 201005-0920-003 · OMB 0920-0741.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix_F.1 ADI_R.pdf	Other-WORD
Appendix_F.3 Study Start Services and Treatment Questionnaire 2007.doc	Other-WORD
Appendix_F.2 Study Start EDQ 2007.doc	Other-WORD
Appendix_F.4 Vineland.pdf	Other-WORD

IC Title:

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_F.1 ADI_R.pdf	Yes	Yes	Fillable Printable
Other-WORD	Appendix_F.3 Study Start Services and Treatment Questionnaire 2007.doc	Yes	Yes	Fillable Printable
Other-WORD	Appendix_F.2 Study Start EDQ 2007.doc	Yes	Yes	Fillable Printable
Other-WORD	Appendix_F.4 Vineland.pdf	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: 107

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	107	-3,943	4,050
Annual IC Time Burden (Hours)	375	-2,325	2,700
Annual IC Cost Burden (Dollars)	0	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.