Information Collection

Methods to Enhance Child Assent Practices (for Parents and Children)

IC 201420 under ICR 201107-0925-005 · OMB 0925-0590.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1.1 Methods to Enhance Child Assent Practices (for Parents and Children)	Form
A.6 LOI3-INF-04-A Focus Group Questions for Parents.docx	Instruction
A.7 LOI3-INF-04-A Child Parent Interviews.docx	Instruction
1.1 Contact Information Form A.3 LOI3-INF-04-A Contact Information Form.docx	Form
A.8 LOI3-INF-04-A Study Protocol.docx A.8 LOI3-INF-04-A Study Protocol	IC Document
A.2 LOI3-INF-04-A Recruitment Flyer.docx A.2 LOI3-INF-04-A Recruitment Flyer	IC Document
A.4 LOI3-INF-04-A Letter to Parents.docx A.4 LOI3-INF-04-A Letter to Parents	IC Document
A.5 LOI3-INF-04-A Consent Form.doc A.5 LOI3-INF-04-A Consent Form	IC Document
A.9 LOI3-INF-04-A IRB Application Submission.doc A.9 LOI3-INF-04-A IRB Application Submission	IC Document
A.10 LOI3-INF-04-A IRB Approval Letter.pdf A.10 LOI3-INF-04-A IRB Approval Letter	IC Document
A.1 LOI3-INF-04-A OIRA Template.doc A.1 LOI3-INF-04-A OIRA Template	IC Document

IC Title:

Agency IC Tracking Number:

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	1.1	Contact Information Form	A.3 LOI3-INF-04-A Contact Information Form.docx	Yes	Yes	Fillable Printable
Instruction			A.6 LOI3-INF-04-A Focus Group Questions for Parents.docx	Yes	Yes	Paper Only
Instruction			A.7 LOI3-INF-04-A Child Parent Interviews.docx	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 110

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 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	385	0	0	0	0	0
Annual IC Time Burden (Hours)	272	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
A.8 LOI3-INF-04-A Study Protocol	A.8 LOI3-INF-04-A Study Protocol.docx	02/21/2012
A.2 LOI3-INF-04-A Recruitment Flyer	A.2 LOI3-INF-04-A Recruitment Flyer.docx	02/16/2012
A.4 LOI3-INF-04-A Letter to Parents	A.4 LOI3-INF-04-A Letter to Parents.docx	02/16/2012
A.5 LOI3-INF-04-A Consent Form	A.5 LOI3-INF-04-A Consent Form.doc	02/16/2012
A.9 LOI3-INF-04-A IRB Application Submission	A.9 LOI3-INF-04-A IRB Application Submission.doc	02/21/2012
A.10 LOI3-INF-04-A IRB Approval Letter	A.10 LOI3-INF-04-A IRB Approval Letter.pdf	02/21/2012
A.1 LOI3-INF-04-A OIRA Template	A.1 LOI3-INF-04-A OIRA Template.doc	02/21/2012

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