Component A ONLY (Subsequent 6-month and 2-year submission) - INTERVIEW

Performance Measurement and Program Monitoring (Autism and Developmental Disabilities Monitoring (ADDM) Network

Documents and Forms

Document Name Document Type
Component A ONLY (Subsequent 6-month and 2-year submission) - INTERVIEW Form and Instruction
ADDM Interview Items Attachment 4B_Interview Items.xlsx Form and Instruction

Information Collection (IC) Details

IC Title:	Component A ONLY (Subsequent 6-month and 2-year submission) - INTERVIEW	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	ADDM Interview Items	Attachment 4B_Interview Items.xlsx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.