Sub-Study Alabama Outreach (NICHD)

Generic Clearance to Support the Safe to Sleep Campaign at the Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0701 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Sub-Study Alabama Outreach (NICHD) Form and Instruction
1 Alabama Outreach Standard applicaiton 0925-0701_Substudy_AlabamaOutreach_ StandardApplication.docx Form and Instruction
2 Alabama Outreach Activity Tracking 0925-0701_Substudy_AlabamaOutreach_ ActivityTracking.docx Form and Instruction
3 Alabama Outreach BeforeAndAfter Activity Knowledge Check 0925-0701_Substudy_AlabamaOutreach_ BeforeAndAfterActivityKnowledgeCheck.docx Form and Instruction
0925-0701_Substudy_AlabamaOutreach_ MiniSSA.rev.docx Mini SSA IC Document
0925-0701_Substudy_AlabamaOutreach_ MiniSSB.DOCX Mini SSB IC Document
0925-0701_Substudy_AlabamaOutreach_ Paperwork Checklist.docx Alabama Outreach Paper Checklist IC Document
0925-0701_Substudy_AlabamaOutreach_ Sign in Sheet.docx AlabamaOutreach Sign in Sheet IC Document
0925-0701_Substudy_AlabamaOutreach_PhotoVideoConsent.docx AlabamaOutreach PhotoVideo Consent IC Document

Information Collection (IC) Details

IC Title:	Sub-Study Alabama Outreach (NICHD)	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Alabama Outreach Standard applicaiton	0925-0701_Substudy_AlabamaOutreach_ StandardApplication.docx	Yes	Yes	Fillable Fileable
Form and Instruction	2	Alabama Outreach Activity Tracking	0925-0701_Substudy_AlabamaOutreach_ ActivityTracking.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3	Alabama Outreach BeforeAndAfter Activity Knowledge Check	0925-0701_Substudy_AlabamaOutreach_ BeforeAndAfterActivityKnowledgeCheck.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,644	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,644	2,644
Annual IC Time Burden (Hours)	291	291
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Mini SSA	0925-0701_Substudy_AlabamaOutreach_ MiniSSA.rev.docx	03/12/2018
Mini SSB	0925-0701_Substudy_AlabamaOutreach_ MiniSSB.DOCX	03/12/2018
Alabama Outreach Paper Checklist	0925-0701_Substudy_AlabamaOutreach_ Paperwork Checklist.docx	03/12/2018
AlabamaOutreach Sign in Sheet	0925-0701_Substudy_AlabamaOutreach_ Sign in Sheet.docx	03/12/2018
AlabamaOutreach PhotoVideo Consent	0925-0701_Substudy_AlabamaOutreach_PhotoVideoConsent.docx	03/12/2018

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