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Attachment F |
Autism Intervention Research Program Questionnaire |
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OMB Number: XXXX-NEW
Expiration Date
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is XXXX-XXXX. Public reporting burden for this collection of information is estimated to average ____ minutes per respondent annually, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14-33, Rockville, Maryland, 20857.
Combating Autism Act Initiative (CAAI)
Autism Intervention R40 Grantee
Data Collection Form
(Two Year Grant Programs)
In the table below, please provide the requested information regarding the activities funded by your R40 grant and your accomplishments.
Primary Data Collection Focus
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Study Populations
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Highlights of Findings
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In the table below, please provide the racial, ethnic, and gender composition of the study dataset.
Race |
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White |
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African American |
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Asian |
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American Indian/Alaska Native |
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Native Hawaiian/Pacific Islander |
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More than One Race |
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Unknown or Not Reported |
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Ethnicity |
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Hispanic |
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Non-Hispanic |
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Unknown |
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Gender |
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Male |
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Female |
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Elaboration/Comments:
R40 Grant Program Research Output
In the table below, please provide the requested information, as available, for any articles or publications generated as a result of your R40 grant. Please use the following codes to indicate the stage of the work in the status row:
P - in preparation
S - submitted
A - accepted
P - published
Title |
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Journal |
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Citation |
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Abstract |
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Status |
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Title |
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Journal |
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Citation |
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Abstract |
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Status |
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Title |
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Journal |
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Citation |
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Abstract |
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Status |
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Elaboration/Comments:
| File Type | application/msword |
| File Title | Attachment F |
| Subject | Autism Intervention Research Program Questionnaire |
| File Modified | 2010-04-22 |
| File Created | 2010-04-22 |