Health Care Providers

Recruitment Strategy Substudy for the National Children's Study (NICHD)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0593 can be found here:

Documents and Forms

Document Name Document Type
Form C.9.3 Health Care Providers Form and Instruction
C.9.3 Instruments C.9.3 Healthcare Provider Questionnaire.doc Form and Instruction
A.2.1 Instruments A.2.1.h Participant Evaluation Questionnaire_Revised.doc Form and Instruction
A.2.3 Instruments A.2.3.l Blood Draw Data Collection Form_Revised.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Health Care Providers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	C.9.3	Instruments	C.9.3 Healthcare Provider Questionnaire.doc	Yes	Yes	Paper Only
Form and Instruction	A.2.1	Instruments	A.2.1.h Participant Evaluation Questionnaire_Revised.doc	Yes	Yes	Paper Only
Form and Instruction	A.2.3	Instruments	A.2.3.l Blood Draw Data Collection Form_Revised.doc	Yes	Yes	Paper Only

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-165	165
Annual IC Time Burden (Hours)	-8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.