Alabama Safe Sleep Outreach Project

Generic Clearance to Support the Safe to Sleep Campaign at the Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0701 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Alabama Safe Sleep Outreach Project Form
1 Alabama Outreach Activity Tracking form 0925-0701_Substudy_AlabamaOutreach_Activity_Tracking - 10.26.16.pdf Form
2 Alabama Outreach Assessment Form 0925-0701_Substudy_AlabamaOutreach_Assessment_Form.pdf Form
3 Alabama Outreach Photo Video Consent Form 0925-0701_Substudy_AlabamaOutreach_Photo_Video_Consent_Form.pdf Form
4 Alabama Outreach Required Form 0925-0701_Substudy_AlabamaOutreach_Required_Forms.pdf Form
5 Alabama Outreach Sign In Sheet 0925-0701_Substudy_AlabamaOutreach_Sign_In_Sheet.pdf Form
0925-0701_Substudy_AlabamaOutreach_ MiniSSA 11.1.16.docx Mini SSA Alabama Safe Sleep Outreach IC Document
0925-0701_Substudy_AlabamaOutreach_ MiniSSB 10.26.16.docx Mini SSB Alabama Safe Sleep Outreach IC Document

Information Collection (IC) Details

IC Title:	Alabama Safe Sleep Outreach Project	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	1	Alabama Outreach Activity Tracking form	0925-0701_Substudy_AlabamaOutreach_Activity_Tracking - 10.26.16.pdf	No	Paper Only
Form	2	Alabama Outreach Assessment Form	0925-0701_Substudy_AlabamaOutreach_Assessment_Form.pdf	No	Paper Only
Form	3	Alabama Outreach Photo Video Consent Form	0925-0701_Substudy_AlabamaOutreach_Photo_Video_Consent_Form.pdf	No	Paper Only
Form	4	Alabama Outreach Required Form	0925-0701_Substudy_AlabamaOutreach_Required_Forms.pdf	No	Paper Only
Form	5	Alabama Outreach Sign In Sheet	0925-0701_Substudy_AlabamaOutreach_Sign_In_Sheet.pdf	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service,	FR Citation: 67 FR 70642

Number of Respondents: 2,630	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,630	2,630
Annual IC Time Burden (Hours)	319	319
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Mini SSA Alabama Safe Sleep Outreach	0925-0701_Substudy_AlabamaOutreach_ MiniSSA 11.1.16.docx	11/01/2016
Mini SSB Alabama Safe Sleep Outreach	0925-0701_Substudy_AlabamaOutreach_ MiniSSB 10.26.16.docx	11/01/2016

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