Information Collection Request

Generic Clearance to Support the Safe to Sleep Campaign at the Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD)

ICR 201403-0925-009 · OMB 0925-0701 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 5 Alabama Outreach Sign In Sheet Form New Available
Form 4 Alabama Outreach Required Form Form New Available
Form 3 Alabama Outreach Photo Video Consent Form Form New Available
Form 2 Alabama Outreach Assessment Form Form New Available
Form 1 Alabama Outreach Activity Tracking form Form New Available
Form 4 Substudy AlabamaOutreach Signin Form and Instruction New Available
Form 3 Substudy AlabamaOutreach Activity/Tracking Form and Instruction New Available
Form 2 Substudy AlabamaOutreach PrePostAssessment Form and Instruction New Available
Form 1 Substudy AlabamaOutreach PaperworkChecklist Form and Instruction New Available
Form 1 National Champions Tracking and Feedback Screenshots Form and Instruction New Available
Form 1 National Champions Tracking and Feedback Screenshots Form and Instruction New Available
Form 1 National Champions Tracking and Feedback Screenshots Form and Instruction New Available
Form 1 Healthy Native Babies Project Materials Distribution Tracking Form Form and Instruction New Available
Form 1 Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment Survey Form and Instruction New Available
Form 1 Tracking Form Form and Instruction New Available
Form 1 Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment Survey Form and Instruction New Available
Attach 1B_Sub-study Memo Template.doc Supplementary Document Uploaded 2014-05-29 Available
Attach 1A_Generic Information Collection Request ICR Template.doc Supplementary Document Uploaded 2014-05-29 Available
SSB_Safe_To_Sleep_Campaign_NICHD_3-28-14.docx Supporting Statement B Uploaded 2014-05-29 Available
SSA_Safe_To_Sleep_Campaign_NICHD_7-21-14. REV.doc Supporting Statement A Uploaded 2014-07-29 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
224261 Alabama Safe Sleep Outreach Project Form NewAlabama Outreach Sign In Sheet
224261 Alabama Safe Sleep Outreach Project Form NewAlabama Outreach Required Form
224261 Alabama Safe Sleep Outreach Project Form NewAlabama Outreach Photo Video Consent Form
224261 Alabama Safe Sleep Outreach Project Form NewAlabama Outreach Assessment Form
224261 Alabama Safe Sleep Outreach Project Form NewAlabama Outreach Activity Tracking form
220000 Alabama Safe Sleep Outreach Project Form and Instruction NewSubstudy AlabamaOutreach Signin
220000 Alabama Safe Sleep Outreach Project Form and Instruction NewSubstudy AlabamaOutreach Activity/Tracking
220000 Alabama Safe Sleep Outreach Project Form and Instruction NewSubstudy AlabamaOutreach PrePostAssessment
220000 Alabama Safe Sleep Outreach Project Form and Instruction NewSubstudy AlabamaOutreach PaperworkChecklist
214193 Safe to Sleep National Champions Tracking and Feedback Form Form and Instruction NewNational Champions Tracking and Feedback Screenshots
214192 Safe to Sleep National Champions Tracking and Feedback Form Form and Instruction NewNational Champions Tracking and Feedback Screenshots
214191 Safe to Sleep National Champions Tracking and Feedback Form Form and Instruction NewNational Champions Tracking and Feedback Screenshots
213926 Healthy Native Babies (HNB) Project Materials Distribution Form and Instruction NewHealthy Native Babies Project Materials Distribution Tracking Form
213921 Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment Form and Instruction NewHealthy Native Babies Project Train-the-Trainer Follow-Up Assessment Survey
213751 Healthy Native Babies Project Materials Distribution Form and Instruction NewTracking Form
213691 Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment Form and Instruction NewHealthy Native Babies Project Train-the-Trainer Follow-Up Assessment Survey

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2017 36 Months From Approved
7,500 0 0
3,000 0 0
0 0 0





Reginfo record details
9
table that charts list of burden
IC Title Form No. Form Name
Alabama Safe Sleep Outreach Project 3, 1, 2, 4 ,   ,   ,  
Alabama Safe Sleep Outreach Project 4, 2, 3, 5, 1 ,   ,   ,   ,  
Healthy Native Babies (HNB) Project Materials Distribution 1
Healthy Native Babies Project Materials Distribution 1
Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment 1
Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment 1
Safe to Sleep National Champions Tracking and Feedback Form 1
Safe to Sleep National Champions Tracking and Feedback Form 1
Safe to Sleep National Champions Tracking and Feedback Form 1

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 7,500 0 0 7,500 0 0
Annual Time Burden (Hours) 3,000 0 0 3,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No