Information Collection

Sub-Study Alabama Outreach (NICHD)

IC 230667 under ICR 201710-0925-003 · OMB 0925-0701.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Sub-Study Alabama Outreach (NICHD)

Agency IC Tracking Number:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.