Information Collection

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

IC 197493 under ICR 201204-0915-001 · OMB 0915-0344.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ATTACH_P_scoring_PedsQL_v6.pdf	Instruction
PedsQL Pediatric Quality of Life Inventory for children and ado PedsQL Version 4.0 ShortForm (SF15).pdf	Form and Instruction

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
Instruction			ATTACH_P_scoring_PedsQL_v6.pdf		Yes	No	Printable Only
Form and Instruction	PedsQL	Pediatric Quality of Life Inventory for children and adolescents age 18 or younger	PedsQL Version 4.0 ShortForm (SF15).pdf		Yes	Yes	Fillable Fileable

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	Previously Approved
Annual Number of Responses for this IC	450	0	450
Annual IC Time Burden (Hours)	90	-23	113
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.