Self Administered Forms (Mother)

The Study to Explore Early Development (SEED) - Phase 3 (Modified for COVID-19 Impact Assessment)

OMB: 0920-1171

IC ID: 224015

Documents and Forms
Document Name
Document Type
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IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Self Administered Forms (Mother) 16PA
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Attachment 8.a. Maternal Medical History _ SEED 3.doc No   Fillable Printable
Other-WORD Attachment 8.b. Paternal and Occupational Medical History SEED 3.doc No   Fillable Printable
Other-WORD Attachment 8.c. Child Health History Form SEED 3.docx No   Fillable Printable
Other-WORD Attachment 8.d. Maternal and Child Residential History Form SEED 3.doc No   Fillable Printable
Other-WORD Attachment 8.e. Child Behavior Check List (CBCL) SEED 3.pdf No   Fillable Printable
Other-WORD Attachment 8.f. Social Responsiveness Scale (Preschool).pdf No   Fillable Printable
Other-WORD Attachment 8.g. Social Responsiveness Scale (Child).pdf No   Fillable Printable
Other-WORD Attachment 8.h. Services and Treatments Questionnaire SEED 3.docx No   Fillable Printable
Other-WORD Attachment 8.k. Yellow FolderInstr_Things to keep SEED 3_ASD POP.doc No   Fillable Printable
Other-WORD Attachment 8.i._Cover letter SEED 3_ ASD POP.docx No   Paper Only
Other-WORD Attachment 8.l. Green Folder Inst_Checklist_Things to return_SEED 3_ASD.doc No   Paper Only
Other-WORD Attachment 8.o. Medical Glossary for Maternal Paternal and Child Health Forms.doc No   Fillable Fileable
Other-WORD Attachment 8.p. Self Admin Forms Consent SEED 3 ASD, POP, and DD.doc No   Fillable Fileable Signable

Health Health Care Services

09-20-0136: Epidemiologic Studies and Surveillance of Disease Problems   57 FR 62812

375 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 375 0 0 0 0 375
Annual IC Time Burden (Hours) 656 0 0 0 0 656
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att 8e_CoverSheet Attachment 8.e. CoverSheet_Child Behavior Check List (CBCL) SEED 3..doc 10/19/2016
Att 8f_Coversheet Attachment 8.f. CoverSheet_Social Responsiveness Scale (Preschool).doc 10/19/2016
Att 8g_CoverSheet Attachment 8.g. CoverSheet_Social Responsiveness Scale (Child).doc 10/19/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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