Information Collection

24-Month Interview (PB, EH, TT-HI, TT-LI, PBS)

IC 193579 under ICR 201205-0925-002 · OMB 0925-0593.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 24.4 24-Month Interview (PB, EH, TT-HI, TT-LI, PBS)	Form and Instruction
24.1 Survey 24 MO Interview 20120413.docx	Form and Instruction
24.2 Survey Modified Checklist for Autism in Toddlers SAQ 20120413.docx	Form and Instruction
24.3 Survey - Placeholder for copyrighted material 24 MO ASQ-3.docx	Form and Instruction
24.4 Survey - Placeholder for copyrighted material 27 MO ASQ-3.docx	Form and Instruction
24.5 Survey - Placeholder for copyrighted material 30 MO ASQ-3.docx	Form and Instruction
Note to File - 24 Month -- Administration of Ages and Stages 3 Questionnaire.docx Note to File - 24-Month ASQ Administration	IC Document

IC Title:

24-Month Interview (PB, EH, TT-HI, TT-LI, PBS)

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	24.4	Survey - Placeholder for copyrighted material	27 MO ASQ-3.docx	Yes	Yes	Paper Only
Form and Instruction	24.5	Survey - Placeholder for copyrighted material	30 MO ASQ-3.docx	Yes	Yes	Paper Only
Form and Instruction	24.1	Survey	24 MO Interview 20120413.docx	Yes	Yes	Paper Only
Form and Instruction	24.2	Survey	Modified Checklist for Autism in Toddlers SAQ 20120413.docx	Yes	Yes	Paper Only
Form and Instruction	24.3	Survey - Placeholder for copyrighted material	24 MO ASQ-3.docx	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: 1,251

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	1,251	-884	2,135
Annual IC Time Burden (Hours)	730	-338	1,068
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Note to File - 24-Month ASQ Administration	Note to File - 24 Month -- Administration of Ages and Stages 3 Questionnaire.docx	04/16/2012

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