Information Collection

Enrollment Packet - ASD (Mother)

IC 224012 under ICR 201910-0920-002 · OMB 0920-1171.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1171 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 18. Participant Flow Chart_revised.docx	Other-WORD
Attachment 11.a. Overall Consent _ASD SEED 3_revised.doc	Other-WORD
Att 20.a. Enrollment Packet Cover Letter ASD and POP SEED 3_3-7-17.docx Att 20a_Cover Letter	IC Document

IC Title:

Enrollment Packet - ASD (Mother)

Agency IC Tracking Number:

16PA

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Attachment 11.a. Overall Consent _ASD SEED 3_revised.doc		Yes	Yes	Fillable Fileable
Other-WORD			Attachment 18. Participant Flow Chart_revised.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: 09-20-0136: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 469

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	Previously Approved
Annual Number of Responses for this IC	469	469
Annual IC Time Burden (Hours)	156	156
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 20a_Cover Letter	Att 20.a. Enrollment Packet Cover Letter ASD and POP SEED 3_3-7-17.docx	03/16/2017

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