Information Collection

Developmental Projects and Special Studies

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0950 can be found here:

2026-03-04 - No material or nonsubstantive change to a currently approved collection
2025-05-01 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att_14_Spec_Studies 17-18 101816.docx	Instruction
Att 2b Blood - Infants Form 083117.docx	Other-Protocol for the Infant Blood
Att 4b WIN Form 081817.docx	Other-Link to Protocol for the Words
Forms for the Balance Vestibular Visual Function Pilot S Att 1b Balance Forms 081817.docx	Form and Instruction
Att_4_Developmental Project Reports.docx Att Development Project Reports	IC Document
Att 1a Balance 081817.docx Description of the Balance Vestibular Visual Function Study	IC Document
Att 2a Blood - Infants 083117.docx Description of the Infant Blood Draw Pilot Study	IC Document
Att 3a EConsent Description 083117.docx Description of the e-Signature for Consent Pilot Study	IC Document
Att 3b Adult Consent HC 081817.docx Consent-Assent and Parental Permission Form	IC Document
Att 3c Child Assent HC 081817.docx Child Assent Form	IC Document
Att 3d Future Research HC 081817.doc Consent-Assent and Parental Permission Form for Future Research	IC Document
Att 3e Transport Auth HC 083117.doc Authorization for Transportation Arrangements	IC Document
Att 3f Child_Brochure HC 081817.PDF Assent Brochure for Children	IC Document
Att 3g Adult Brochure_Cover HC 081817.pdf Cover for the Adult Consent Brochure	IC Document
Att 3h Adult_Brochure_Inside HC 081817.pdf Contents of the Adult Consent Brochure	IC Document
Att 3i assent 7-11 081817.docx e-Consent (assent) screen for ages 7-11	IC Document
Att 3j assent 12-17 081817.docx e-Consent (assent) screen for ages 12-17	IC Document
Att 4a WIN Description 083117.docx Description of the Words-in-Noise Pilot Study	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Developmental Projects and Special Studies

Agency IC Tracking Number:

0920-0950

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	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

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Health Resources Utilization Statistics

FR Citation: 49 FR 37693

Number of Respondents: 3,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	3,500	3,500
Annual IC Time Burden (Hours)	10,500	10,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.