OMB control number

Zika Outcomes and Development of Infants and Children (ZODIAC) Investigation

OMB 0920-1194 · HHS/CDC.

OMB 0920-1194

Latest Forms, Documents, and Supporting Material

Document Name
Blood Draw Form and Instruction
Vision Exam Form and Instruction
Neurological Exam - Hammersmith Infant Neurologic Exam / Evaluation of Cerebral Palsy Form and Instruction
Physical Health Exam Form and Instruction
Growth Exam Form and Instruction
Parenting Stress Index - Short Form Form and Instruction
Patient Health Questionniare - 9 Form and Instruction
Ages and Stages Questionnaire - Social / Emotional Form and Instruction
Ages and Stages Questionniare - 3rd Edition Form and Instruction
Seizure Screen Form and Instruction
Parent Questionnaire Form and Instruction
Medical Record Abstraction Form Form and Instruction
Recruitment and Participation Log Form
SSB - ZODIAC Emergency ICR_submitted 7_14_17.docx Supporting Statement B
SSA - ZODIAC Emergency ICR_submitted_7-14-17.docx Supporting Statement A
Emergency Review Request Memo - ZODIAC Investigation_signed 7-14-17.pdf Supplementary Document
Att. 12 - ZODIAC Non-Research Determination.docx Supplementary Document
Att. 11 - Public Health Handsouts for Families with Babies with Microcephaly.docx Supplementary Document
Att. 10 - List of ZODIAC Measures.docx Supplementary Document
Att. 6 - Consent and Assent Forms.docx Supplementary Document
Att. 5 - Public Health Handouts.docx Supplementary Document
Att. 4 - Introductory Script.docx Supplementary Document
Att. 1 - Authorizing Legislation.docx Supplementary Document
Blood Draw Form and Instruction
Vision Exam Form and Instruction
Neurological Exam - Hammersmith Infant Neurologic Exam / Evaluation of Cerebral Palsy Form and Instruction
Physical Health Exam Form and Instruction
Growth Exam Form and Instruction
Parenting Stress Index - Short Form Form and Instruction
Patient Health Questionniare - 9 Form and Instruction
Ages and Stages Questionnaire - Social / Emotional Form and Instruction
Ages and Stages Questionniare - 3rd Edition Form and Instruction
Seizure Screen Form and Instruction
Parent Questionnaire Form and Instruction
Medical Record Abstraction Form Form and Instruction
Recruitment and Participation Log Form

All Historical Document Collections

201707-0920-007

Approved without change

New collection (Request for a new OMB Control Number)

2017-07-17