Information Collection

LOI2-QUEX-25-B, "National Children's Study Recruitment and Retention Network"

IC 197614 under ICR 200802-0925-003 · OMB 0925-0590.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0590 can be found here:

Documents and Forms

Document Name Document Type
Form 1 LOI2-QUEX-25-B, "National Children's Study Recruitment and Retention Network" Form and Instruction
1 Screening Tool Exemplar Screening Tool LOI2-QUEX-25 20110325.doc Form and Instruction
2 Moderator's Guide Exemplar_Moderator_Guide_LOI2-QUEX-25_20110405[1].docx Form and Instruction
Formative Research OMB Review Template LOI2-QUEX-25 20110331.docx Formative Research OMB Review Template LOI2-QUEX-25 20110331 IC Document
Exemplar Informed Consent LOI2-QUEX-25 20110405.docx Exemplar Informed Consent LOI2-QUEX-25 20110405 IC Document
NCS GC Cover Memorandum 20110331a.docx NCS GC Cover Memorandum 20110331a IC Document
Exemplar Brochure LOI2-QUEX-25 20110526.pdf Exemplar brochure IC Document
Exemplar Recruitment Letter LOI2-QUEX-25 20110526a.doc Exemplar Recruitment Letter IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	LOI2-QUEX-25-B, "National Children's Study Recruitment and Retention Network"	Agency IC Tracking Number:

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	1	Screening Tool	Exemplar Screening Tool LOI2-QUEX-25 20110325.doc		No	No	Fillable Printable
Form and Instruction	2	Moderator's Guide	Exemplar_Moderator_Guide_LOI2-QUEX-25_20110405[1].docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	240	0	0	0	0	0
Annual IC Time Burden (Hours)	240	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Formative Research OMB Review Template LOI2-QUEX-25 20110331	Formative Research OMB Review Template LOI2-QUEX-25 20110331.docx	05/04/2011
Exemplar Informed Consent LOI2-QUEX-25 20110405	Exemplar Informed Consent LOI2-QUEX-25 20110405.docx	05/04/2011
NCS GC Cover Memorandum 20110331a	NCS GC Cover Memorandum 20110331a.docx	05/04/2011
Exemplar brochure	Exemplar Brochure LOI2-QUEX-25 20110526.pdf	05/26/2011
Exemplar Recruitment Letter	Exemplar Recruitment Letter LOI2-QUEX-25 20110526a.doc	05/26/2011

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