Information Collection

SEED- Clinic Visit - Control Parent

IC 178553 under ICR 201005-0920-003 · OMB 0920-0741.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix_F.4 Vineland.pdf	Other-WORD
Appendix_E.3 Study Start Informed Consent NIC- Sub 2007.doc Appendix_E	IC Document

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
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: 80

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	80	-2,234	2,314
Annual IC Time Burden (Hours)	60	-332	392
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix_E	Appendix_E.3 Study Start Informed Consent NIC- Sub 2007.doc	04/26/2010

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