Sickle Cell Disease Treatment Demonstration Program (SCDTDP) Evaluation - PedsQL for children & adolescents

Sickle Cell Disease Program Evaluations

Documents and Forms

Document Name Document Type
ATTACH_P_scoring_PedsQL_v6.pdf Instruction
PedsQL Pediatric Quality of Life Inventory for children and ado PedsQL Version 4.0 ShortForm (SF15).pdf Form and Instruction

Information Collection (IC) Details

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

Is this a Common Form? No		IC Status: Modified

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
Instruction			ATTACH_P_scoring_PedsQL_v6.pdf		Yes	No	Printable Only
Form and Instruction	PedsQL	Pediatric Quality of Life Inventory for children and adolescents age 18 or younger	PedsQL Version 4.0 ShortForm (SF15).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 225	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	Previously Approved
Annual Number of Responses for this IC	450	0	450
Annual IC Time Burden (Hours)	90	-23	113
Annual IC Cost Burden (Dollars)	0	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.