Information Collection

DD- PRE-ENROLLMENT Invitation Packet/Response Card (Mother)

IC 224182 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⚠️ Notice: This information collection may be referencing outdated material.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
Att 19.b. Invitation Letter SEED Phase 3_DD_3-7-17.docx	Other-WORD
Att 19.g. Response Card SEED 3_3-7-17.docx	Other-WORD
Att 19.e. Study Brochure SEED 3_version DD_3-7-17.docx	Other-WORD
Attachment 9.e. CoverSheet_ADOS-2 Score Sheet Module-2 SEED-3_9_19_16.doc Att 19g_Study Brochure	IC Document

IC Title:

DD- PRE-ENROLLMENT Invitation Packet/Response Card (Mother)

Agency IC Tracking Number:

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD	Att 19.b. Invitation Letter SEED Phase 3_DD_3-7-17.docx	No		Paper Only
Other-WORD	Att 19.g. Response Card SEED 3_3-7-17.docx	No		Fillable Fileable
Other-WORD	Att 19.e. Study Brochure SEED 3_version DD_3-7-17.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 641

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	641	641
Annual IC Time Burden (Hours)	107	107
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 19g_Study Brochure	Attachment 9.e. CoverSheet_ADOS-2 Score Sheet Module-2 SEED-3_9_19_16.doc	10/27/2016

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