Att 5_Cover Sheet

Attachment 5

Form Approved

OMB NO. 0920-XXXX

Exp. Date XX/XX/20XX

Date of Completion: _________________

Study to Explore Early Development

Social Communication Questionnaire

Public reporting burden of this collection of information is estimated to average 30 minutes, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74,  Atlanta, Georgia 30333; ATTN:  PRA (0920-0010).

Thank you for completing this questionnaire.

Version 3: March 2006 Page 1 of 6