Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS)

Forms and Documents

Document Name	Status
Form 17 Short Strengths and Difficulties Questionnaire--Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS) - line 4 Form and Instruction	New
Form 13 Child and Adolescent Psychiatric Assessment : Child Version Form and Instruction	New
Form 8 Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS) - line 2 Child and Adolescent Psychiatric Assessment : Parent Version Form and Instruction	New
Form 1 Pre-School Psychiatric Assessment Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS) - line 1 Form	New
Attachment H Updated Advance Letters Informed Consent 4-6-2011 to OMB.docx Supplementary Document	2011-04-06
Att A Applicable Laws.doc Supplementary Document	2011-02-04
Att H Advance Letters Informed Consent.doc Supplementary Document	2011-02-04
SS Part B.doc Supporting Statement B	2011-02-04
SS Part A.doc Supporting Statement A	2011-02-04

IC Document Collections

IC ID	Document Title	Status
196126	Short Strengths and Difficulties Questionnaire--Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS) - line 4 Form and Instruction	New
196125	Child and Adolescent Psychiatric Assessment : Child Version Form and Instruction	New
196124	Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS) - line 2 Child and Adolescent Psychiatric Assessment : Parent Version Form and Instruction	New
196123	Pre-School Psychiatric Assessment Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS) - line 1 Form	New

ICR Details

OMB Control No: 0920-0884	ICR Reference No: 201102-0920-008
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/06/2011
	Date Received in OIRA: 02/04/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2013	24 Months From Approved
Responses	1,102	0	0
Time Burden (Hours)	633	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Short Strengths and Difficulties Questionnaire is a five item mental health screening questionnaire designed to assess the mental health of children 4 years and older. The purpose of the proposed study is to calibrate the scores of this questionnaire against diagnostic psychiatric interviews to establish the cut-off score that best determines serious emotional disturbance.

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Authorizing Statute(s): US Code: 42 USC 242 Name of Law: National Center for Health Statistics
   US Code: 42 USC 290 Name of Law: Center for Mental Health Services
   US Code: 41 USC 306 Name of Law: National Center for Health Statistics
   PL: Pub.L. 111 - 5 115 Name of Law: American Recovery and Reinvestment Act of 2009
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 29552	05/26/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 74053	11/30/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Short Strengths and Difficulties Questionnaire--Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS) - line 4	17	Short Strengths and Difficulties Questionnaire
Pre-School Psychiatric Assessment Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS) - line 1	1, 2, 3, 4, 7, 6, 5	The Electronic Pre-School Psychiatric Assessment ,   Pre-School Psychiatric Assessment ,   Pre-School Psychiatric Assessment ,   Pre-School Psychiatric Assessment ,   Pre-School Psychiatric Assessment ,   Pre-School Psychiatric Assessment ,   Pre-School Psychiatric Assessment
Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS) - line 2 Child and Adolescent Psychiatric Assessment : Parent Version	10, 8, 11, 12, 9	The Child and Adolescent Psychiatric Assessment (CAPA) ,   Child and Adolescent Psychiatric Assessment (Parent) ,   Child and Adolescent Psychiatric Assessment : Parent Version ,   Child and Adolescent Psychiatric Assessment : Parent Version ,   Child and Adolescent Psychiatric Assessment (parent)
Child and Adolescent Psychiatric Assessment : Child Version	14, 15, 16, 13	Child and Adolescent Psychiatric Assessment : Child Version ,   Child and Adolescent Psychiatric Assessment : Child Version ,   Child and Adolescent Psychiatric Assessment : Child Version ,   Child and Adolescent Psychiatric Assessment : Child Version

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ICR Summary 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	1,102	0	0	1,102	0	0
Annual Time Burden (Hours)	633	0	0	633	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new ICR.

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Annual Cost to Federal Government: $736,149

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Yes

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/04/2011

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