Information Collection

Social Responsiveness Scale

IC 227867 under ICR 201708-0920-011 · OMB 0920-1219.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Social Responsiveness Scale	Form
Social Responsiveness Scale Attachment 6.d.2 - Social Responsiveness Scale.pdf	Form
Attachment 6.d. Cover Sheet for Social Responsiveness Scale.doc Cover Sheet	IC Document
Attachment 6.d.1 - SEED Teen Social Responsiveness Scale Instructions_ver Feb 2018.docx Social Responsiveness Scale Instructions	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	none	Social Responsiveness Scale	Attachment 6.d.2 - Social Responsiveness Scale.pdf		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Epidemiologic Studies and Surveilance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 142

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
Annual Number of Responses for this IC	142	142
Annual IC Time Burden (Hours)	47	47
Annual IC Cost Burden (Dollars)	824	824

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Cover Sheet	Attachment 6.d. Cover Sheet for Social Responsiveness Scale.doc	08/09/2017
Social Responsiveness Scale Instructions	Attachment 6.d.1 - SEED Teen Social Responsiveness Scale Instructions_ver Feb 2018.docx	02/28/2018

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