Information Collection

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

IC 224011 under ICR 202102-0920-008 · OMB 0920-1171.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 5. Social Communication Questionnaire (SCQ).pdf	Other-WORD
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
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
Attachment 5 CoverSheet_Social Communication Questionnaire (SCQ) pdf.doc Att 5_Cover Sheet	IC Document

IC Title:

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 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 %

table that charts list of burden
	Approved	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

table that charts IC Documents
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.