Information Collection on Cause-Specific Absenteeism in Schools

ICR 202108-0920-002

OMB: 0920-1039

Federal Form Document

Forms and Documents

Document Name	Status
Form 0920-1039 Household Component - Household Study Form B (Day 0, 7, and 14) Form	New
Form 0920-1039 Household Component - Household Study Form B Form	Modified
Form 0920-1039 Student Component - Household Study Form A Form	Modified
18) Form	Modified
Form 0920-1039 Student Component - ORCHARDS Telephone Screen Form and Instruction	Modified
OMB changes document with consents 8.17.21.docx Supplementary Document	2021-08-26
20200406 REDCap PIA signed.pdf Supplementary Document	2021-08-16
Att C3 - consent_assent forms.docx Supplementary Document	2021-08-16
Att C3a Assent 7 - 14.pdf Supplementary Document	2021-08-16
Att C1 - School District Approval Letter.pdf Supplementary Document	2021-08-16
Att. D4 - orchards newspaper ad.pdf Supplementary Document	2017-10-27
Att D2 - Recruitment Flyer_teenager.docx Supplementary Document	2021-08-16
Att D3 - Recruitment Flyer_kid.docx Supplementary Document	2021-08-16
Att D1 - participant packet.pdf Supplementary Document	2021-08-02
Att C5 IRB Approval_22Jan2021.pdf Supplementary Document	2021-08-16
Att C6 -CDC IRB Deferral.pdf Supplementary Document	2021-08-16
Published 60-day FRN.pdf Supplementary Document	2021-08-02
Non-Substantive Change 0920-1039 ARI and Influenze Survillance Form.docx Justification for No Material/Nonsubstantive Change	2015-12-28
SupStaA_WI School Absenteeism_final.docx Supporting Statement A	2021-08-16
Att A3- Sec 301 PHSA (42 USC 241).pdf Supplementary Document	2021-08-02
Att A2- CFR part 70.pdf Supplementary Document	2021-08-02
Att A1- Sec 361 PHSA (42 USC 264).pdf Supplementary Document	2021-08-02
SupStaB_WI School Absenteeism_final.docx Supporting Statement B	2021-08-16

IC Document Collections

IC ID	Document Title	Status
248917	Household Component - Biospecimen Collection (Day 0, 7 and 14) Instruction	New
248916	Household Component - Household Study Form B (Day 0, 7, and 14) Form	New
248914	Household Component - Biospecimen Collection (Day 7 and 14) Instruction	New
228818	Household Component - Household Study Form B Form	Modified
228817	Student Component - Biospecimen Collection (Day 0) Instruction	Modified
228816	Student Component - Household Study Form A Form	Modified
212417	18) Form	Modified
212402	Student Component - ORCHARDS Telephone Screen Form and Instruction	Modified