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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
American Academy of Pediatrics Neurodevelopmental (ECHO)
Agency IC Tracking Number:
0920-1154-20MC
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
0920-1154
Peditrician - ECHO Chart Review
ATTACH A1_AAP Neurodevelopment ECHO Chart Review instrument_OMB_June 2020 response_clean copy.docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
0920-1154
Pediatrician - ECHO Session Satisfaction Survey
ATTACH A2_AAP Neurodevelopment ECHO Session Satisfaction Survey.docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
0920-1154
Pediatrician - ECHO Program Satisfaction Survey
ATTACH A3_AAP Neurodevelopment ECHOProgram Satisfaction Survey_OMB_June 2020 Response_clean copy.docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
0920-1154
Pediatrician - ECHO Debriefing Conference Call
ATTACH A4_AAP Neurodevelopment ECHO Program Debriefing conf call.pdf
NA
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Training and Employment
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
60
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
100 %
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
2,550
0
2,550
0
0
0
Annual IC Time Burden (Hours)
507
0
507
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
GenIC Template
GenICRequestTemplate_AAP Neurodevelopmnt ECHO_revised Jan 2 2020_June 2020 Responses to OMB_clean copy.docx
06/18/2020
IRB Review
AAP Neurodevelopment ECHO IRB.docx
06/18/2020
ECHO - PIA
RE_ PIA process question_inquiry .pdf
06/18/2020
Supporting Statement A
SupportingStatementPartA_AAP Neurodevelopment ECHO_revised Jan 2 2020_OMB_June 2020 response_clean copy.docx
06/18/2020
Supporting Statement B
SupportingStatementPartB_AAP Neurodevelopment ECHO.docx
06/18/2020
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.