Adult Form

[NCBDDD] Documenting Outcomes Associated with Persistent Tic Disorders (Including Tourette Syndrome) in Children, Adolescents, and Young Adults Through Surveillance

Documents and Forms

Document Name Document Type
Adult Form Form and Instruction
Adult Form Att 3_Adult forms_KJ.docx Form and Instruction
Adult Form Att_3 Adult forms.pdf Form and Instruction
Att 8_Adult Forms in REDCap.pdf Adult Redcap copy IC Document
Att 8_Adult Forms in REDCap.pdf Adult Redcap copy IC Document

Information Collection (IC) Details

IC Title:	Adult Form	Agency IC Tracking Number:	0920-24EG

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Adult Form	Att_3 Adult forms.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136, Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62811

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Adult Redcap copy	Att 8_Adult Forms in REDCap.pdf	09/22/2025

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