[PHIC/NCIRD] Pediatric Hepatitis-Adenovirus Case Control Evaluation, United States 2022-2026 (24CN)

[NCSTLTPHIW] Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

OMB: 0920-0879

IC ID: 264737

Documents and Forms

Document Name Document Type
Form 0920-0879 [PHIC/NCIRD] Pediatric Hepatitis-Adenovirus Case Control Evaluation, United States 2022-2026 (24CN) Form and Instruction
0920-0879 PEDIATRIC HEPATITIS OF UNKNOWN ETIOLOGY MEDICAL RECORD ABSTRACTION FORM Attachment A_Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form Controls_17Jan2024.docx Form and Instruction
0920-0879 Pediatric Hepatitis of Unknown Etiology - Exposures Questionnaire (Parental Interview) Attachment B_Pediatric Hepatitis of Unknown Etiology - Exposures Questionnaire [Parental Interview]_17Jan2024.docx Form and Instruction
0920-0879 Pediatric Hepatitis of Unknown Etiology - Exposures Questionnaire CONTROL (Parental Interview) Attachment C_Pediatric Hepatitis of Unknown Etiology - Exposures Questionnaire CONTROL [Parental Interview]_17Jan2024.docx Form and Instruction
0920-0879 Hepatitis pediátrica de etiología desconocida - Cuestionario sobre exposiciones (entrevista a los padres) Att D_Hepatitis pediátrica de etiología desconocida - Cuestionario sobre exposiciones (entrevista a los padres). 8Dec2023.docx Form and Instruction
0920-0879 Hepatitis pediátrica de etiología desconocida. CONTROL del cuestionario sobre exposiciones (Entrevista a los padres) Att E_Hepatitis pediátrica de etiología desconocida CONTROL del uestionario sobre exposiciones_8Dec2023.docx Form and Instruction
CSTLTS Generic Supporting_Statement_A_Guideline File_17Jan2024.docx SSA IC Document
CSTLTS Generic Supporting_Statement_B_Guideline File_17Jan2024.docx SSB IC Document