Information Collection

Undetermined agent for hepatitis among children <10 years of age – United States, 2022

IC 254913 under ICR 202201-0920-010 · OMB 0920-1011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1011 Appendix 1: Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF) Undetermined agent for hepatitis among children <10 years of age – United States, 2022	Form and Instruction
Form 0920-1011 Appendix 2: Pediatric Hepatitis of Unknown Etiology- Exposures Questionnaire (Parental Interview) Undetermined agent for hepatitis among children <10 years of age – United States, 2022	Form and Instruction
Form 0920-1011 Appendix 3: Domestic Hepatitis-Adenovirus Investigation Consent Undetermined agent for hepatitis among children <10 years of age – United States, 2022	Form and Instruction
Form 0920-1011 Appendix 4: Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form: Controls (CRF) Undetermined agent for hepatitis among children <10 years of age – United States, 2022	Form and Instruction
Form 0920-1011 Appendix 5: Pediatric Hepatitis of Unknown Etiology- Exposures Questionnaire: Controls (Parental Interview) Undetermined agent for hepatitis among children <10 years of age – United States, 2022	Form and Instruction
Form 0920-1011 Appendix 6: Domestic Hepatitis-Adenovirus Investigation Consent: Controls (residual blood) Undetermined agent for hepatitis among children <10 years of age – United States, 2022	Form and Instruction
Form 0920-1011 Appendix 7: Pediatric Hepatitis of Unknown Etiology- Exposures Questionnaire (Parental Interview) - SPANISH Undetermined agent for hepatitis among children <10 years of age – United States, 2022	Form and Instruction
Form 0920-1011 Appendix 8: Domestic Hepatitis-Adenovirus Investigation Consent - SPANISH Undetermined agent for hepatitis among children <10 years of age – United States, 2022	Form and Instruction

Information Collection (IC) Details

Record metadata
IC Title	Undetermined agent for hepatitis among children <10 years of age – United States, 2022