Information Collection

9-Month Interview

IC 193576 under ICR 201407-0925-005 · OMB 0925-0593.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 13.1 9-Month Interview	Form and Instruction
13.1 Survey 9MonthQuestionnaireChild.docx	Form and Instruction
HIPAAHealthUseDisclosureAuthorizationForm.docx HIPAAHealthUseDisclosureAuthorizationForm	IC Document
Attach 10. Informed Consent Form - Adult.docx InformedConsentFormAdult	IC Document
Attach 12. Parental Permission Child Participation - Birth to 6Months.docx ParentalPermissionChildParticipation6MonthtoAgeMajority	IC Document
Attach 13. Multi-Mode Visit Information Script.docx MultiModeVisitInformationScript	IC Document

IC Title:

9-Month Interview

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
Form and Instruction	13.1	Survey	9MonthQuestionnaireChild.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: 554

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	Previously Approved
Annual Number of Responses for this IC	554	554
Annual IC Time Burden (Hours)	127	127
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HIPAAHealthUseDisclosureAuthorizationForm	HIPAAHealthUseDisclosureAuthorizationForm.docx	01/14/2014
InformedConsentFormAdult	Attach 10. Informed Consent Form - Adult.docx	07/24/2014
ParentalPermissionChildParticipation6MonthtoAgeMajority	Attach 12. Parental Permission Child Participation - Birth to 6Months.docx	07/24/2014
MultiModeVisitInformationScript	Attach 13. Multi-Mode Visit Information Script.docx	07/24/2014

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