Sickle Cell Disease Treatment Demonstration Program (SCDTDP) Evaluation - PedsQL for Parents

Sickle Cell Disease Program Evaluations

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0344 can be found here:

Documents and Forms

Document Name Document Type
ATTACH_P_scoring_PedsQL_v6.pdf Instruction
005_Sickle Cell_Pe 005_Sickle Cell_PedsQL_Parents_Teens ATTACH_K_PedsQL-4.0-Core-PA_teens.doc Form
005_Sickle Cell_Pe 005_Sickle Cell_PedsQl_Parents_kids8-12 ATTACH_L_PedsQL-4.0-Core-PC_kids_8-12.doc Form
005_Sickle Cell_Si 005_Sickle Cell_Sickle Cell_PedsQL_toddlers ATTACH_M_PedsQL-4.0-Core-PT_todd_2-4.doc Form
005_Sickle Cell_Pe 005_Sickle Cell_PedsQL_Parents_kids5-7 ATTACH_N_PedsQL-4.0-Core-PYC_kids_5-7.doc Form

Information Collection (IC) Details

IC Title:	Sickle Cell Disease Treatment Demonstration Program (SCDTDP) Evaluation - PedsQL for Parents	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			ATTACH_P_scoring_PedsQL_v6.pdf	Yes	No	Printable Only
Form	005_Sickle Cell_PedsQL_Parents_Teens	005_Sickle Cell_PedsQL_Parents_Teens	ATTACH_K_PedsQL-4.0-Core-PA_teens.doc	Yes	Yes	Fillable Fileable
Form	005_Sickle Cell_PedsQl_Parents_kids8-12	005_Sickle Cell_PedsQl_Parents_kids8-12	ATTACH_L_PedsQL-4.0-Core-PC_kids_8-12.doc	Yes	Yes	Fillable Fileable
Form	005_Sickle Cell_Sickle Cell_PedsQL_toddlers	005_Sickle Cell_Sickle Cell_PedsQL_toddlers	ATTACH_M_PedsQL-4.0-Core-PT_todd_2-4.doc	Yes	Yes	Fillable Fileable
Form	005_Sickle Cell_PedsQL_Parents_kids5-7	005_Sickle Cell_PedsQL_Parents_kids5-7	ATTACH_N_PedsQL-4.0-Core-PYC_kids_5-7.doc	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 270	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	540	540
Annual IC Time Burden (Hours)	135	135
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.