Information Collection Request

Longitudinal follow-up of Youth with Attention-Deficit/Hyperactivity Disorder identified in Community Settings: Examining Health Status, Correlates, and Effects associated with treatment for ADHD

ICR 201002-0920-008 · OMB 0920-0747 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Attachment B35. Teachery Survery (Teacher) Form and Instruction Removed Available
Attachment B34. Youth Demographic Survey (16+ years) (Child) Form and Instruction Removed Available
Attachment B33. People In My Life/Inventory of Parent and Peer Attachment Form and Instruction Removed Available
Attachment B32. People In My Life (Child) Form and Instruction Removed Available
Attachment B31. Pediatric Quality of Life (teen) (Child) Form and Instruction Removed Available
Attachment B30. Pediatric Quality of Life (child) (Child) Form and Instruction Removed Available
Form 28 ATTACHMENT C29: Teacher Survey Form and Instruction Modified Available
Form 27 ATTACHMENT C28: Youth Demographic Survey (16 plus years) Form Modified Available
Form 26 ATTACHMENT C27: Pediatric Quality of Life (Teen 13 plus) Form and Instruction Modified Available
Form 25 ATTACHMENT C26: Pediatric Quality of Life (Child 8-12) Form and Instruction Modified Available
Form 24 ATTACHMENT C25: Olweus Bullying Quesstionnaire (High School, 14 plus years) Form Modified Available
Form 23 ATTACHMENT C24: Social Inventory (High School, 14 plus years) Form and Instruction Modified Available
Form 22 ATTACHMENT C23: MARSH Self Description Questionnaire, 16 plus years Form and Instruction Modified Available
Form 21 ATTACHMENT C22: MARSH Self Description Questionnaire, 13-15 years Form and Instruction Modified Available
Form 20 ATTACHMENT C21: MARSH Self Description Questionnaire, 7-12 years Form and Instruction Modified Available
Form 19 ATTACHMENT C20: Health Risk Behavior Survey (High School) Form Modified Available
Form 18 ATTACHMENT C19: Health Risk Behavior Survey (Middle School) Form Modified Available
Form 17 ATTACHMENT C18: Conflict in Adolescent Dating Relationships Form Modified Available
Form 16 ATTACHMENT C17: Child Brief Sensation Seeking Scale Form Modified Available
Form 15 ATTACHMENT C16: Vanderbilt Rating Scale Form and Instruction Modified Available
Form 14 ATTACHMENT C15: Parent Strengths and Difficulties Questionnaire Form and Instruction Modified Available
Form 13 ATTACHMENT C14: Parent Social Isolation/Support Form and Instruction Modified Available
Form 12 ATTACHMENT C13: Quarterly Update: Critical School Events Form Modified Available
Form 11 ATTACHMENT C12: Parents' Questionnaire (Mental Health) Form and Instruction Modified Available
Form 10 ATTACHMENT C11: Parent Child Relationship Inventory Form and Instruction Modified Available
Form 9 ATTACHMENT C10: Health Risk Behavior Survey (High School) Form Modified Available
Form 8 ATTACHMENT C9: Health Risk Behavior Survey (Middle School) Form Modified Available
Form 7 ATTACHMENT C8: Parent Demographic Survey Form Modified Repair queued
Form 6 ATTACHMENT C7: Parent Critical Events Form (High School) Form and Instruction Modified Available
Form 5 ATTACHMENT C6: Parent Critical Events Form (Middle School) Form and Instruction Modified Available
Form 4 ATTACHMENT C5: Parent Brief Impairment Scale Form and Instruction Modified Available
Form 3 ATTACHMENT C4B: Parent ADHD Treatment Quarterly Update Form Modified Repair queued
Form 2 ATTACHMENT C4A: Parent ADHD Treatment, Cost, and Client Satisfaction Questionnaire Form Modified Available
Form 1 ATTACHMENT C3: Parent ADHD Communication and Knowledge Form and Instruction Modified Available
Amended IRB_App_Ltr.pdf Supplementary Document Uploaded 2010-05-07 Available
SS.B 20100127.doc Supporting Statement B Uploaded 2010-02-05 Available
Attachment List Justification ADHD follow up extension 20100127.doc Supplementary Document Uploaded 2010-02-05 Available
Attachment G SC Triage Protocol Document 3-13-07.doc Supplementary Document Uploaded 2010-02-05 Available
Attachment F2 Age distributions SC.doc Supplementary Document Uploaded 2010-02-05 Available
Attachment F1 sample description.doc Supplementary Document Uploaded 2010-02-05 Available
Attachment E3 CDC reliance agreement.pdf Supplementary Document Uploaded 2010-02-05 Available
Attachment E2 SC IRB review.pdf Supplementary Document Uploaded 2010-02-05 Available
Attachment E1 CDC 5042 IRB Approval of Continuation of Protocol (Expedited).doc Supplementary Document Uploaded 2010-02-05 Available
Attachment D3 SC PLAY Youth Consent for Research (18+) 12-02-2009.doc Supplementary Document Uploaded 2010-02-05 Available
Attachment D2 SC PLAY Child Assent for Research (age 9-17) 12-02-2009.doc Supplementary Document Uploaded 2010-02-05 Available
Attachment D1 SC Parent Consent (age 9-17) 12-02-09.doc Supplementary Document Uploaded 2010-02-05 Available
Attachment C30 DISC-IV Table of Contents.doc Supplementary Document Uploaded 2010-02-05 Available
Attachment C2 Instrument descriptions for new or modified surveys.doc Supplementary Document Uploaded 2010-02-05 Available
Attachment C1 Instrument Table.doc Supplementary Document Uploaded 2010-02-05 Available
Attachment_B_60_Day_FRN_ADHD.pdf Supplementary Document Uploaded 2010-02-05 Available
Attachment A2 Children's Health Act 2000.pdf Supplementary Document Uploaded 2010-02-05 Available
Attachment A1 Public Health Service Act 2000.pdf Supplementary Document Uploaded 2010-02-05 Available
SS.A 20100127.doc Supporting Statement A Uploaded 2010-02-23 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
179858 Attachment B35. Teachery Survery (Teacher) Form and Instruction Removed
179857 Attachment B34. Youth Demographic Survey (16+ years) (Child) Form and Instruction Removed
179856 Attachment B33. People In My Life/Inventory of Parent and Peer Attachment Form and Instruction Removed
179855 Attachment B32. People In My Life (Child) Form and Instruction Removed
179854 Attachment B31. Pediatric Quality of Life (teen) (Child) Form and Instruction Removed
179853 Attachment B30. Pediatric Quality of Life (child) (Child) Form and Instruction Removed
179852 ATTACHMENT C29: Teacher Survey Form and Instruction Modified
179851 ATTACHMENT C28: Youth Demographic Survey (16 plus years) Form Modified
179850 ATTACHMENT C27: Pediatric Quality of Life (Teen 13 plus) Form and Instruction Modified
179849 ATTACHMENT C26: Pediatric Quality of Life (Child 8-12) Form and Instruction Modified
179848 ATTACHMENT C25: Olweus Bullying Quesstionnaire (High School, 14 plus years) Form Modified
179847 ATTACHMENT C24: Social Inventory (High School, 14 plus years) Form and Instruction Modified
179846 ATTACHMENT C23: MARSH Self Description Questionnaire, 16 plus years Form and Instruction Modified
179845 ATTACHMENT C22: MARSH Self Description Questionnaire, 13-15 years Form and Instruction Modified
179844 ATTACHMENT C21: MARSH Self Description Questionnaire, 7-12 years Form and Instruction Modified
179843 ATTACHMENT C20: Health Risk Behavior Survey (High School) Form Modified
179842 ATTACHMENT C19: Health Risk Behavior Survey (Middle School) Form Modified
179841 ATTACHMENT C18: Conflict in Adolescent Dating Relationships Form Modified
179840 ATTACHMENT C17: Child Brief Sensation Seeking Scale Form Modified
179839 ATTACHMENT C16: Vanderbilt Rating Scale Form and Instruction Modified
179838 ATTACHMENT C15: Parent Strengths and Difficulties Questionnaire Form and Instruction Modified
179837 ATTACHMENT C14: Parent Social Isolation/Support Form and Instruction Modified
179836 ATTACHMENT C13: Quarterly Update: Critical School Events Form Modified
179835 ATTACHMENT C12: Parents' Questionnaire (Mental Health) Form and Instruction Modified
179834 ATTACHMENT C11: Parent Child Relationship Inventory Form and Instruction Modified
179833 ATTACHMENT C10: Health Risk Behavior Survey (High School) Form Modified
179832 ATTACHMENT C9: Health Risk Behavior Survey (Middle School) Form Modified
179831 ATTACHMENT C8: Parent Demographic Survey Form Modified
179830 ATTACHMENT C7: Parent Critical Events Form (High School) Form and Instruction Modified
179829 ATTACHMENT C6: Parent Critical Events Form (Middle School) Form and Instruction Modified
179828 ATTACHMENT C5: Parent Brief Impairment Scale Form and Instruction Modified
179827 ATTACHMENT C4B: Parent ADHD Treatment Quarterly Update Form Modified
179826 ATTACHMENT C4A: Parent ADHD Treatment, Cost, and Client Satisfaction Questionnaire Form Modified
179825 ATTACHMENT C3: Parent ADHD Communication and Knowledge Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2013 36 Months From Approved 07/31/2010
6,029 0 29,943
765 0 3,993
0 0 0





Reginfo record details
28
table that charts list of burden
IC Title Form No. Form Name
ATTACHMENT C3: Parent ADHD Communication and Knowledge 1 ATTACHMENT C3: Parent ADHD Communication and Knowledge
ATTACHMENT C4A: Parent ADHD Treatment, Cost, and Client Satisfaction Questionnaire 2 ATTACHMENT C4A: Parent ADHD Treatment, Cost, and Client Satisfaction Questionnaire
ATTACHMENT C4B: Parent ADHD Treatment Quarterly Update 3 ATTACHMENT C4B: Parent ADHD Treatment Quarterly Update
ATTACHMENT C5: Parent Brief Impairment Scale 4 ATTACHMENT C5: Parent Brief Impairment Scale
ATTACHMENT C6: Parent Critical Events Form (Middle School) 5, None ATTACHMENT C6: Parent Critical Events Form (Middle School) ,   Critical School Events (elementary, middle)
Attachment B35. Teachery Survery (Teacher) None Teacher Survey
ATTACHMENT C7: Parent Critical Events Form (High School) 6 ATTACHMENT C7: Parent Critical Events Form (High School)
ATTACHMENT C8: Parent Demographic Survey 7 ATTACHMENT C8: Parent Demographic Survey
ATTACHMENT C9: Health Risk Behavior Survey (Middle School) 8 ATTACHMENT C9: Health Risk Behavior Survey (Middle School)
ATTACHMENT C10: Health Risk Behavior Survey (High School) 9 ATTACHMENT C10: Health Risk Behavior Survey (High School)
ATTACHMENT C11: Parent Child Relationship Inventory 10 ATTACHMENT C11: Parent Child Relationship Inventory
ATTACHMENT C12: Parents' Questionnaire (Mental Health) 11 ATTACHMENT C12: Parents' Questionnaire (Mental Health)
ATTACHMENT C13: Quarterly Update: Critical School Events 12 ATTACHMENT C13: Quarterly Update: Critical School Events
ATTACHMENT C14: Parent Social Isolation/Support 13 ATTACHMENT C14: Parent Social Isolation/Support
ATTACHMENT C15: Parent Strengths and Difficulties Questionnaire 14 ATTACHMENT C15: Parent Strengths and Difficulties Questionnaire
ATTACHMENT C16: Vanderbilt Rating Scale 15 ATTACHMENT C16: Vanderbilt Rating Scale
ATTACHMENT C17: Child Brief Sensation Seeking Scale 16 ATTACHMENT C17: Child Brief Sensation Seeking Scale
ATTACHMENT C18: Conflict in Adolescent Dating Relationships 17 ATTACHMENT C18: Conflict in Adolescent Dating Relationships
ATTACHMENT C19: Health Risk Behavior Survey (Middle School) 18 ATTACHMENT C19: Health Risk Behavior Survey (Middle School)
ATTACHMENT C20: Health Risk Behavior Survey (High School) 19 ATTACHMENT C20: Health Risk Behavior Survey (High School)
ATTACHMENT C21: MARSH Self Description Questionnaire, 7-12 years 20 ATTACHMENT C21: MARSH Self Description Questionnaire, 7-12 years
ATTACHMENT C22: MARSH Self Description Questionnaire, 13-15 years 21 ATTACHMENT C22: MARSH Self Description Questionnaire, 13-15 years
ATTACHMENT C23: MARSH Self Description Questionnaire, 16 plus years 22 ATTACHMENT C23: MARSH Self Description Questionnaire, 16 plus years
ATTACHMENT C24: Social Inventory (High School, 14 plus years) 23 ATTACHMENT C24: Social Inventory (High School, 14 plus years)
ATTACHMENT C25: Olweus Bullying Quesstionnaire (High School, 14 plus years) 24 ATTACHMENT C25: Olweus Bullying Quesstionnaire (High School, 14 plus years)
ATTACHMENT C26: Pediatric Quality of Life (Child 8-12) 25 ATTACHMENT C26: Pediatric Quality of Life (Child 8-12)
ATTACHMENT C27: Pediatric Quality of Life (Teen 13 plus) 26 ATTACHMENT C27: Pediatric Quality of Life (Teen 13 plus)
ATTACHMENT C28: Youth Demographic Survey (16 plus years) 27 ATTACHMENT C28: Youth Demographic Survey (16 plus years)
ATTACHMENT C29: Teacher Survey 28 ATTACHMENT C29: Teacher Survey
Attachment B30. Pediatric Quality of Life (child) (Child) None Pediatric Quality of Life (Child)
Attachment B31. Pediatric Quality of Life (teen) (Child) None Pediatric Quality of Life (teen)
Attachment B32. People In My Life (Child) None People In My Life
Attachment B33. People In My Life/Inventory of Parent and Peer Attachment None People In My Life/Inventory of Parent and Peer Attachment
Attachment B34. Youth Demographic Survey (16+ years) (Child) None Youth Demographic Survey (16+ years)

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 6,029 29,943 0 -23,914 0 0
Annual Time Burden (Hours) 765 3,993 0 -3,228 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No