Pre--pregnancy interview July Launch VIS 20100615

OMB NUMBER 0925‐0593 

EXPIRATION DATE: XXXXX 
Recruitment Substudy Pre‐Pregnancy Interview 

National Children’s Study Visit Information Sheet: Pre-pregnancy Interview
Thank you for participating in the National Children’s Study. When you joined the
Study, we explained what it means to take part in this important research effort. This
sheet gives more details about what we’d like to do during this visit.
What will happen during today’s visit?
•

This interview will take no more than 20 minutes to complete. We will ask you some
questions about yourself, your health and pregnancy, your lifestyle, and where you live.

•

You can decide what questions you want to answer. If you feel uncomfortable about any
question, you can skip it.

When can I expect to hear from the Study again?
•

We will contact you in a few months to see if you are eligible for other Study visits.

Will I be paid for taking part in today’s visit?
•

To thank you for your time, we will give you $25 for today’s visit.

What if I have questions about this visit?
•

If you have any questions about this visit, you can ask the Study representative you’re
talking with today. If he or she can’t answer a question, we will give you the name and
phone number of someone from our local office who can.

Please remember:
y

Whether or not you stay in the National Children’s Study is your choice.

y

If you leave the Study, you can rejoin it later.

y

You can decide whether or not you want to stay in the Study.

•

If you leave the Study, we will not ask you for any new information, but we will keep
using the information you have already given us. We will keep everything that you tell
us confidential.

y

If you decide you do not want us to keep the information we have collected from you,
you can ask us to destroy it.

y

If we learn that you or someone else is harming you, your child, or others around you,
we may be required by law to report this to the police or a social services agency in your
community.

y

This is a research study and we cannot give you medical advice. None of the Study visits
take the place of your regular doctor or clinic visits.

Public reporting burden for this collection of information is estimated to average 5 minutes per response, including
the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed,
and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless it displays a currently valid OMB
control number. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge
Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0593). Do not return the completed form to this
address.

VIS6MA