Information Collection

American Academy of Pediatrics Neurodevelopmental (ECHO)

IC 242188 under ICR 201912-0920-003 · OMB 0920-1154.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.