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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 1 Screening Tool LOI2-QUEX-25-B, "National Children's Study Recruitment and Retention Network"	Form and Instruction
Form 2 Moderator's Guide 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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.