Information Collection

Kappa Safe Infant Sleep Community Engagement Project (NICHD)

IC 231956 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⚠️ Notice: This information collection may be referencing outdated material.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 Kappa Safe Infant Sleep Community Engagement Project (NICHD)	Form and Instruction
1 KAPPA Activity Tracker 0925-0701_Substudy_KAPPA_Activity tracker.docx	Form and Instruction
2 KAPPA Mini-Grant Applicaiton 0925-0701_Substudy_Kappa_Mini-Grant Application.docx	Form and Instruction
3 Kappa Before After Activity Knowledge Check 0925-0701_Substudy_KAPPA_Before After Activity Knowledge Check.docx	Form and Instruction
0925-0701_Substudy_Kappa_2018_MiniSSA - revised.docx Mini Supporting Statement A (Mini SSA)	IC Document
0925-0701_Substudy_Kappa_2018_MiniSSB.docx Mini Supporting Statement B (Mini SSB)	IC Document

IC Title:

Kappa Safe Infant Sleep Community Engagement Project (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?	Electronic Capability
Form and Instruction	1	KAPPA Activity Tracker	0925-0701_Substudy_KAPPA_Activity tracker.docx	No	Paper Only
Form and Instruction	2	KAPPA Mini-Grant Applicaiton	0925-0701_Substudy_Kappa_Mini-Grant Application.docx	No	Paper Only
Form and Instruction	3	Kappa Before After Activity Knowledge Check	0925-0701_Substudy_KAPPA_Before After Activity Knowledge Check.docx	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: âClinical, Basic and Population-based Research Studies of the National Institutes of Health (NIH), HHS/NIH/OD"

FR Citation: 67 FR 60742

Number of Respondents: 1,632

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,632	1,632
Annual IC Time Burden (Hours)	216	216
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Mini Supporting Statement A (Mini SSA)	0925-0701_Substudy_Kappa_2018_MiniSSA - revised.docx	06/27/2018
Mini Supporting Statement B (Mini SSB)	0925-0701_Substudy_Kappa_2018_MiniSSB.docx	06/27/2018

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