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Clinic/Home Visit - Developmental Assessment (Child)
The Study to Explore Early Development (SEED) - Phase 3 (Modified for COVID-19 Impact Assessment)
OMB: 0920-1171
IC ID: 224167
OMB.report
HHS/CDC
OMB 0920-1171
ICR 202102-0920-008
IC 224167
( )
Documents and Forms
Document Name
Document Type
Attachment 9.a. Mullenscoresheet SEED 3.pdf
Other-WORD
Attachment 9.a. Mullenscoresheet SEED 3.pdf
Other-WORD
Attachment 16.a. Anthropometric Exam Form SEED 3_tmj8-25-17.doc
Other-WORD
Attachment 16.a. Anthropometric Exam Form SEED 3_tmj8-25-17.doc
Other-WORD
Attachment 16.b. Saliva Collection Instructions Form SEED 3.docx
Instruction
Attachment 16.b. Saliva Collection Instructions Form SEED 3.docx
Instruction
Attachment 16.c. Saliva Consent Form SEED 3.docx
Other-WORD
Attachment 16.c. Saliva Consent Form SEED 3.docx
Other-WORD
Attachment 16.d. Saliva Transmittal Form SEED 3_tmj8-25-17.doc
Other-WORD
Attachment 16.d. Saliva Transmittal Form SEED 3_tmj8-25-17.doc
Other-WORD
Attachment 17.b. Adult Blood Draw Form SEED 3_tmj8-25-17.doc
Other-WORD
Attachment 17.b. Adult Blood Draw Form SEED 3_tmj8-25-17.doc
Other-WORD
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Clinic/Home Visit - Developmental Assessment (Child)
Agency IC Tracking Number:
16PA
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 9.a. Mullenscoresheet 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.b. Adult Blood Draw Form SEED 3_tmj8-25-17.doc
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
234
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
234
0
0
0
0
234
Annual IC Time Burden (Hours)
351
0
0
0
0
351
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.