OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Self Administered Forms

IC 224189 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
Instruction
Instruction
Other-ord
Other-ord
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Self Administered Forms 16 PA
 
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 Fileable
Other-WORD Attachment 8.b. Paternal and Occupational Medical History SEED 3.doc No   Fillable Fileable
Other-WORD Attachment 8.c. Child Health History Form SEED 3.docx No   Fillable Fileable
Other-WORD Attachment 8.d. Maternal and Child Residential History Form SEED 3.doc No   Fillable Fileable
Other-WORD Attachment 8.j._Cover letter SEED 3_ DD.docx No   Paper Only
Instruction Attachment 8.k. Yellow FolderInstr_Things to keep SEED 3_ASD POP.doc No   Fillable Fileable
Instruction Attachment 8.m. Green Folder Inst_Checklist_Things to return_SEED 3_DD.doc No   Paper Only
Other-ord Attachment 8.p. Self Admin Forms Consent SEED 3 ASD, POP, and DD.doc No   Fillable Fileable

Health Public Health Monitoring

 

140 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 140 0 0 0 0 140
Annual IC Time Burden (Hours) 128 0 0 0 0 128
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att 80_Medical Glossary for Maternal Paternal and Child Health Forms Attachment 8.o. Medical Glossary for Maternal Paternal and Child Health Forms.doc 10/27/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.