Information Collection

Enrollment Packet (DD)

IC 224184 under ICR 202011-0920-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 11.b. Overall Consent _DD SEED 3_revised.doc	Other-WORD
Attachment 21.b. Invitation Call Script - DD source selection SEED 3_revised.docx	Other-WORD
Attachment 18. Participant Flow Chart_revised.docx Att 18_ Study Flow Chart for Participant	IC Document
Att 20.b. Enrollment Packet Cover Letter DD SEED 3_3-7-17.docx Att 20b_Enrollment Packet Cover Letter DD	IC Document

IC Title:

Enrollment Packet (DD)

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Attachment 11.b. Overall Consent _DD SEED 3_revised.doc		No		Fillable Fileable
Other-WORD			Attachment 21.b. Invitation Call Script - DD source selection SEED 3_revised.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 175

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	175	175
Annual IC Time Burden (Hours)	58	58
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 18_ Study Flow Chart for Participant	Attachment 18. Participant Flow Chart_revised.docx	10/27/2016
Att 20b_Enrollment Packet Cover Letter DD	Att 20.b. Enrollment Packet Cover Letter DD 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.