Information Collection

ENROLLMENT Packet (Mother)

IC 224022 under ICR 202102-0920-008 · OMB 0920-1171.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 20.a. Enrollment Packet Cover Letter ASD and POP SEED 3_3-7-17.docx	Other-WORD
Att 20.a. Enrollment Packet Cover Letter ASD and POP SEED 3_3-7-17.docx	Other-WORD
Attachment 20.c. Bill of rights SEED 3.doc	Instruction
Attachment 20.c. Bill of rights SEED 3.doc	Instruction
Attachment 18. Participant Flow Chart_revised.docx	Other-WORD
Attachment 18. Participant Flow Chart_revised.docx	Other-WORD
Attachment 11.c. Overall Consent _POP SEED 3_revised.doc	Other-WORD
Attachment 11.c. Overall Consent _POP SEED 3_revised.doc	Other-WORD

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	Instrument File	Available Electronically?	Electronic Capability
Other-WORD	Att 20.a. Enrollment Packet Cover Letter ASD and POP SEED 3_3-7-17.docx	No	Paper Only
Instruction	Attachment 20.c. Bill of rights SEED 3.doc	No	Paper Only
Other-WORD	Attachment 18. Participant Flow Chart_revised.docx	No	Paper Only
Other-WORD	Attachment 11.c. Overall Consent _POP SEED 3_revised.doc	No	Fillable Fileable Signable

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: 334

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	334	334
Annual IC Time Burden (Hours)	111	111
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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