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Federal forms, ICRs, and supporting documents

Information Collection

SEED - Medical Record Abstraction

IC 178550 under ICR 201005-0920-003 · OMB 0920-0741.

Documents and Forms
Document Name
Document Type
Other-WORD
Other-WORD
Other-WORD
Other-WORD
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

SEED - Medical Record Abstraction
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Appendix_S.1 Study Start MR release letter - child 2007.doc Yes Yes Fillable Printable
Other-WORD Appendix_S.1 Study Start MR script & fax letter2007.doc Yes Yes Fillable Printable
Other-WORD Appendix_S.1 Study Start MR release letter - mom 2007.doc Yes Yes Fillable Printable
Other-WORD Appendix_S.1.1 CADDRE study start medical records release cover sheets.doc Yes Yes Fillable Printable

Health Public Health Monitoring

09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems  57 FR 62812

347 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 1,735 0 -15,545 0 0 17,280
Annual IC Time Burden (Hours) 87 0 -4,233 0 0 4,320
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Appendix_S Appendix_S.2 Prenatal MR Form FINAL STUDY START VERSION.doc 04/27/2010
Appendix_S Appendix_S.3 Labor and Delivery MR Form Final.doc 04/27/2010
Appendix_S Appendix_S.4 NEONATAL FORM FINAL.DOC 04/27/2010
Appendix_S Appendix_S.5 PEDIATRIC FORM 3.6.09 FINAL.DOC 04/27/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.