Information Collection

ASD - ENROLLMENT-Invitation Call Script and SCQ (Mother)

IC 224011 under ICR 202011-0920-014 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Attachment 5. Social Communication Questionnaire (SCQ).pdf Other-WORD
Att 21.a. Invitation Call Script - Previous ASD Diagnosis SEED 3_3-7-17.docx Other-WORD
Attachment 5 CoverSheet_Social Communication Questionnaire (SCQ) pdf.doc Att 5_Cover Sheet IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	ASD - ENROLLMENT-Invitation Call Script and SCQ (Mother)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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
Other-WORD			Attachment 5. Social Communication Questionnaire (SCQ).pdf		Yes	Yes	Fillable Fileable
Other-WORD			Att 21.a. Invitation Call Script - Previous ASD Diagnosis SEED 3_3-7-17.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 859	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	859	859
Annual IC Time Burden (Hours)	430	430
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 5_Cover Sheet	Attachment 5 CoverSheet_Social Communication Questionnaire (SCQ) pdf.doc	10/19/2016

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