Information Collection

Sickle Cell Disease Treatment Demonstration Program (SCDTDP) Evaluation - PedsQL for children & adolescents

IC 197493 under ICR 201104-0915-003 · OMB 0915-0344.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0344 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 006_Sickle Cell_Pe Sickle Cell Disease Treatment Demonstration Program (SCDTDP) Evaluation - PedsQL for children & adolescents	Form
ATTACH_P_scoring_PedsQL_v6.pdf	Instruction
006_Sickle Cell_Pe 006_Sickle Cell_PedsQL_Child_teens ATTACH_I_PedsQL-4.0-Core-A_child_teens.doc	Form
006_Sickle Cell_Pe 006_Sickle Cell_PedsQL_Child_8-12 ATTACH_J_PedsQL-4.0-Core-C_child_8-12.doc	Form
006_Sickle Cell_Pe 006_Sickle Cell_PedsQL_Child_5-7 ATTACH_O_PedsQL-4.0-Core-YC_child_5-7.doc	Form

IC Title:

Sickle Cell Disease Treatment Demonstration Program (SCDTDP) Evaluation - PedsQL for children & adolescents

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	006_Sickle Cell_PedsQL_Child_teens	006_Sickle Cell_PedsQL_Child_teens	ATTACH_I_PedsQL-4.0-Core-A_child_teens.doc	Yes	Yes	Fillable Fileable
Form	006_Sickle Cell_PedsQL_Child_8-12	006_Sickle Cell_PedsQL_Child_8-12	ATTACH_J_PedsQL-4.0-Core-C_child_8-12.doc	No	Yes	Fillable Fileable
Form	006_Sickle Cell_PedsQL_Child_5-7	006_Sickle Cell_PedsQL_Child_5-7	ATTACH_O_PedsQL-4.0-Core-YC_child_5-7.doc	Yes	Yes	Fillable Fileable
Instruction			ATTACH_P_scoring_PedsQL_v6.pdf	Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 225

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	450	450
Annual IC Time Burden (Hours)	113	113
Annual IC Cost Burden (Dollars)	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.