OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Developmental Projects and Special Studies

IC 219202 under ICR 201708-0920-022 · OMB 0920-0950.

Documents and Forms
Document Name
Document Type
Instruction
Other-Protocol for the Infant Blood
Other-Link to Protocol for the Words
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Developmental Projects and Special Studies 0920-0950
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Att_14_Spec_Studies 17-18 101816.docx Yes Yes Printable Only
Form and Instruction n/a Forms for the Balance Vestibular Visual Function Pilot Study Att 1b Balance Forms 081817.docx No   Paper Only
Other-Protocol for the Infant Blood Draw Pilot Study Att 2b Blood - Infants Form 083117.docx No   Paper Only
Other-Link to Protocol for the Words-in-Noise Pilot Study Att 4b WIN Form 081817.docx No   Paper Only

Health Public Health Monitoring

Health Resources Utilization Statistics  49 FR 37693

3,500 0
   
Individuals or Households
 
   100 %

  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 3,500 0 0 0 0 3,500
Annual IC Time Burden (Hours) 10,500 0 0 0 0 10,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att Development Project Reports Att_4_Developmental Project Reports.docx 11/01/2016
Description of the Balance Vestibular Visual Function Study Att 1a Balance 081817.docx 08/31/2017
Description of the Infant Blood Draw Pilot Study Att 2a Blood - Infants 083117.docx 08/31/2017
Description of the e-Signature for Consent Pilot Study Att 3a EConsent Description 083117.docx 08/31/2017
Consent-Assent and Parental Permission Form Att 3b Adult Consent HC 081817.docx 08/31/2017
Child Assent Form Att 3c Child Assent HC 081817.docx 08/31/2017
Consent-Assent and Parental Permission Form for Future Research Att 3d Future Research HC 081817.doc 08/31/2017
Authorization for Transportation Arrangements Att 3e Transport Auth HC 083117.doc 08/31/2017
Assent Brochure for Children Att 3f Child_Brochure HC 081817.PDF 08/31/2017
Cover for the Adult Consent Brochure Att 3g Adult Brochure_Cover HC 081817.pdf 08/31/2017
Contents of the Adult Consent Brochure Att 3h Adult_Brochure_Inside HC 081817.pdf 08/31/2017
e-Consent (assent) screen for ages 7-11 Att 3i assent 7-11 081817.docx 08/31/2017
e-Consent (assent) screen for ages 12-17 Att 3j assent 12-17 081817.docx 08/31/2017
Description of the Words-in-Noise Pilot Study Att 4a WIN Description 083117.docx 08/31/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.