OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Clinic / Home Visit -Development Assessment (Child)

IC 224019 under ICR 202102-0920-008 · OMB 0920-1171.

Documents and Forms
Document Name
Document Type
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Instruction
Instruction
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Clinic / Home Visit -Development Assessment (Child) 16PA
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Attachment 9.a. Mullenscoresheet SEED 3.pdf No   Fillable Fileable
Other-WORD Attachment 9.d. ADOS-2 Score Sheet Module-1 SEED-3.pdf No   Fillable Fileable
Other-WORD Attachment 9.e. ADOS-2 Score Sheet Module-2 SEED-3.pdf No   Fillable Fileable
Other-WORD Attachment 9.f. ADOS-2 Score Sheet Module-3 SEED-3.pdf No   Fillable Fileable
Other-WORD Attachment 16.a. Anthropometric Exam Form SEED 3_tmj8-25-17.doc No   Fillable Fileable
Instruction Attachment 16.b. Saliva Collection Instructions Form SEED 3.docx No   Paper Only
Other-WORD Attachment 16.c. Saliva Consent Form SEED 3.docx No   Fillable Fileable Signable
Other-WORD Attachment 16.d. Saliva Transmittal Form SEED 3_tmj8-25-17.doc No   Fillable Fileable
Other-WORD Attachment 17.a .Child Blood Draw Form SEED 3_tmj8-25-17.doc No   Fillable Fileable

Health Public Health Monitoring

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

328 0
   
Individuals or Households
 
   0 %

  Approved 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 328 0 0 0 0 328
Annual IC Time Burden (Hours) 738 0 0 0 0 738
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att 9d_CoverSheet Attachment 9.d. CoverSheet_ADOS-2 Score Sheet Module-1 SEED-3.pdf.doc 10/19/2016
Att 9e_CoverSheet Attachment 9.e. CoverSheet_ADOS-2 Score Sheet Module-2 SEED-3.pdf.doc 10/19/2016
Att 9f_CoverSheet Attachment 9.f. CoverSheet_ADOS-2 Score Sheet Module-3 SEED-3.pdf.doc 10/19/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.