Information Collection Request

Pilot Study for the National Children's Study (NICHD)

ICR 200803-0925-005 · OMB 0925-0593 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form C.10.5 Child Care Providers Form and Instruction New Available
Form C.9.4 Community Leaders Form and Instruction New Available
Form C.9.3 Health Care Providers Form and Instruction New Available
Form A.2.2.c Fathers Form and Instruction New Available
Form 1 Postnatal Activities - Mother and Children Form and Instruction New Available
Form A.2.3.L5 Birth Activities-Mother and Children Form and Instruction New Available
Form 1 Pregnancy Activities Form and Instruction New Available
Form A.1.2.b Low Probability Women Form and Instruction New Available
Form A.1.2.b Moderate Probability Women Form and Instruction New Available
Form A.1.2.b High Probability Women w/o Pre-pregnancy Visit Form and Instruction New Available
Form 1 High Probability Women w/Pre-pregnancy Visit Form and Instruction New Available
Form A.1.1.b Eligibility Screening Form and Instruction New Available
Form A.1.1.a2 Household Enumeration Form and Instruction New Available
Appendix C Revised.pdf Supplementary Document Uploaded 2008-09-22 Available
Appendix B Revised.pdf Supplementary Document Uploaded 2008-09-22 Available
IRB Certifications.pdf Supplementary Document Uploaded 2008-09-09 Available
Itemized Burden.doc Supplementary Document Uploaded 2008-09-09 Available
NCS Supporting Statement B.doc Supporting Statement B Uploaded 2008-09-09 Available
C.13 Itemized Burden Estimate Tables.doc Supplementary Document Uploaded 2008-03-24 Available
Appendix C1.pdf Supplementary Document Uploaded 2008-02-28 Available
Appendix B.pdf Supplementary Document Uploaded 2008-02-14 Available
NCS Pilot - Westat IRB Approval Ltr - 2008-01-29.pdf Supplementary Document Uploaded 2008-02-06 Available
NCS Supporting Statement A.doc Supporting Statement A Uploaded 2008-09-09 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
184283 Child Care Providers Form and Instruction New
184282 Community Leaders Form and Instruction New
184281 Health Care Providers Form and Instruction New
184280 Fathers Form and Instruction New
184279 Postnatal Activities - Mother and Children Form and Instruction New
184278 Birth Activities-Mother and Children Form and Instruction New
184277 Pregnancy Activities Form and Instruction New
184276 Low Probability Women Form and Instruction New
184275 Moderate Probability Women Form and Instruction New
184274 High Probability Women w/o Pre-pregnancy Visit Form and Instruction New
184273 High Probability Women w/Pre-pregnancy Visit Form and Instruction New
184272 Eligibility Screening Form and Instruction New
184271 Household Enumeration Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2011 36 Months From Approved
64,598 0 0
13,797 0 0
0 0 0





Reginfo record details
13
table that charts list of burden
IC Title Form No. Form Name
Moderate Probability Women A.1.2.b Survey
Low Probability Women A.1.2.b Survey
Pregnancy Activities 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1 Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey
Birth Activities-Mother and Children A.3.2, A.2.1.h, A.2.3.L5, A.1.1.a, A.1.1.c Survey ,   Survey ,   Survey ,   Survey ,   Survey
Postnatal Activities - Mother and Children 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1 Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survery ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey
Fathers A.2.3.f, A.1.3.b, A.2.2.a, A.2.2.b, A.2.2.c, A.2.2.d, A.2.2.e, A.2.3.b3, A.2.3.f, A.2.3.i, A.2.3.i, A.2.3.j1, A.2.3.j2, A.2.3.j3, A.2.3.L3, A.2.3.m1, A.3.1, A.3.3 Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey
Health Care Providers C.9.3, A.2.1, A.2.3 Instruments ,   Instruments ,   Instruments
Child Care Providers C.10.5 Instruments
High Probability Women w/Pre-pregnancy Visit 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1 Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey ,   Survey
High Probability Women w/o Pre-pregnancy Visit A.1.2.b Survey
Household Enumeration A.1.1.a2, A.1.1.a1, A.1.1.c, A.1.1.a2, A.1.1.c Survey ,   Survey ,   Survey ,   Survey ,   Survey
Eligibility Screening A.1.1.b Survey
Community Leaders C.9.4 Instruments

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 64,598 0 0 64,598 0 0
Annual Time Burden (Hours) 13,797 0 0 13,797 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No