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Supplemental Consent Forms
The Study to Explore Early Development - Teen Follow-up Study (SEED-TEEN)
OMB: 0920-1219
IC ID: 227870
OMB.report
HHS/CDC
OMB 0920-1219
ICR 201708-0920-011
IC 227870
( )
Documents and Forms
Document Name
Document Type
Attachment 7. Cover Sheet for Supplemental Consent Forms.doc
Instruction
Teen consent for future contact
Attachment 7.a - SEED Teen Consent Form for Future Contact_ver Feb 2018.docx
Form and Instruction
Teen consent for genetic sharing - mother
Attachment 7.b.1 - SEED Teen Consent for Genetic Data Sharing_v1 Mother_ver Feb 2018.docx
Form and Instruction
Teen consent for generic data sharing - legal guardian
Attachment 7.b.2 - SEED Teen Consent for Genetic Data Sharing_v2 Legal Guardian_ver Feb 2018.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Supplemental Consent Forms
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Instruction
Attachment 7. Cover Sheet for Supplemental Consent Forms.doc
No
Paper Only
Form and Instruction
none
Teen consent for future contact
Attachment 7.a - SEED Teen Consent Form for Future Contact_ver Feb 2018.docx
No
Paper Only
Form and Instruction
none
Teen consent for genetic sharing - mother
Attachment 7.b.1 - SEED Teen Consent for Genetic Data Sharing_v1 Mother_ver Feb 2018.docx
No
Paper Only
Form and Instruction
none
Teen consent for generic data sharing - legal guardian
Attachment 7.b.2 - SEED Teen Consent for Genetic Data Sharing_v2 Legal Guardian_ver Feb 2018.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
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 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
142
0
142
0
0
0
Annual IC Time Burden (Hours)
12
0
12
0
0
0
Annual IC Cost Burden (Dollars)
206
0
206
0
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.