Follow-up Call Packet

Attachment 5 Form Approved

OMB No. 0920-XXXX

Exp. Date:  XX/XX/XXXX

SEED Teen

SEED Teen Follow-up Call

Checklist of items to be covered during call

1. Introduce self

2. Explain purpose of call

3. Ask if it is ok to tape call for quality assurance purposes

4. Verify that participant received data collection packet

5. Ask if participant had a chance to review materials in data collection packet

6. Inquire if participant had any questions regarding the information provided in the data collection packet (cover letter, SEED Teen Health and Development Survey, Social Responsiveness Scale, two consent forms)

Public reporting burden of this collection of information is estimated to average 10 minutes, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74,  Atlanta, Georgia 30333; ATTN:  PRA (0920-XXXX).