American Academy of Pediatrics Neurodevelopmental (ECHO)

CDC/ATSDR Formative Research and Tool Development

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1154 American Academy of Pediatrics Neurodevelopmental (ECHO) Form and Instruction
0920-1154 Peditrician - ECHO Chart Review ATTACH A1_AAP Neurodevelopment ECHO Chart Review instrument_OMB_June 2020 response_clean copy.docx Form and Instruction
0920-1154 Pediatrician - ECHO Session Satisfaction Survey ATTACH A2_AAP Neurodevelopment ECHO Session Satisfaction Survey.docx Form and Instruction
0920-1154 Pediatrician - ECHO Program Satisfaction Survey ATTACH A3_AAP Neurodevelopment ECHOProgram Satisfaction Survey_OMB_June 2020 Response_clean copy.docx Form and Instruction
0920-1154 Pediatrician - ECHO Debriefing Conference Call ATTACH A4_AAP Neurodevelopment ECHO Program Debriefing conf call.pdf Form and Instruction
GenICRequestTemplate_AAP Neurodevelopmnt ECHO_revised Jan 2 2020_June 2020 Responses to OMB_clean copy.docx GenIC Template IC Document
AAP Neurodevelopment ECHO IRB.docx IRB Review IC Document
RE_ PIA process question_inquiry .pdf ECHO - PIA IC Document
SupportingStatementPartA_AAP Neurodevelopment ECHO_revised Jan 2 2020_OMB_June 2020 response_clean copy.docx Supporting Statement A IC Document
SupportingStatementPartB_AAP Neurodevelopment ECHO.docx Supporting Statement B IC Document

Information Collection (IC) Details

IC Title:	American Academy of Pediatrics Neurodevelopmental (ECHO)	Agency IC Tracking Number:	0920-1154-20MC

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1154	Peditrician - ECHO Chart Review	ATTACH A1_AAP Neurodevelopment ECHO Chart Review instrument_OMB_June 2020 response_clean copy.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1154	Pediatrician - ECHO Session Satisfaction Survey	ATTACH A2_AAP Neurodevelopment ECHO Session Satisfaction Survey.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1154	Pediatrician - ECHO Program Satisfaction Survey	ATTACH A3_AAP Neurodevelopment ECHOProgram Satisfaction Survey_OMB_June 2020 Response_clean copy.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1154	Pediatrician - ECHO Debriefing Conference Call	ATTACH A4_AAP Neurodevelopment ECHO Program Debriefing conf call.pdf	NA	No		Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,550	2,550
Annual IC Time Burden (Hours)	507	507
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC Template	GenICRequestTemplate_AAP Neurodevelopmnt ECHO_revised Jan 2 2020_June 2020 Responses to OMB_clean copy.docx	06/18/2020
IRB Review	AAP Neurodevelopment ECHO IRB.docx	06/18/2020
ECHO - PIA	RE_ PIA process question_inquiry .pdf	06/18/2020
Supporting Statement A	SupportingStatementPartA_AAP Neurodevelopment ECHO_revised Jan 2 2020_OMB_June 2020 response_clean copy.docx	06/18/2020
Supporting Statement B	SupportingStatementPartB_AAP Neurodevelopment ECHO.docx	06/18/2020

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