Information Collection Request

Recruitment Strategy Substudy for the National Children's Study (NICHD)

ICR 201102-0925-002 · OMB 0925-0593 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 8 Survey Form and Instruction Modified Available
Form 7 Survey Form and Instruction Modified Available
Form 6 Survey Form and Instruction Modified Repair queued
Form 3.1 Consent Form and Instruction Modified Available
Form 5.2 Survey Form and Instruction Modified Available
Form 5.1 Survey Form and Instruction Modified Available
Form 4 Survey Form and Instruction Modified Available
Form 2 Survey Form and Instruction Modified Available
Form 9 Survey Form and Instruction Modified Available
Form 9 Survey Form and Instruction Modified Available
Form 5.1 Survey Form and Instruction Modified Available
Form 5.2 Survey Form and Instruction Modified Repair queued
Form 9 Survey Form and Instruction Modified Available
Form 3.3 Consent Form and Instruction Modified Available
Form 3.2 Consent Form and Instruction Modified Available
Form 2.2 Survey Form and Instruction Modified Available
Form 8 Survey Form and Instruction Modified Available
Form 7 Survey Form and Instruction Modified Available
Form 6 Survey Form and Instruction Modified Available
Form 3.1 Consent Form and Instruction Modified Available
Form 5.2 Survey Form and Instruction Modified Available
Form 5.1 Survey Form and Instruction Modified Available
Form 4 Survey Form and Instruction Modified Available
Form 10 Form Form Modified Available
Form 8 Survey Form and Instruction Modified Available
Form 7 Survey Form and Instruction Modified Available
Form 6 Survey Form and Instruction Modified Available
Form 3.1 Consent Form and Instruction Modified Available
Form 5.2 Survey Form and Instruction Modified Available
Form 5.1 Survey Form and Instruction Modified Available
Form 4 Survey Form and Instruction Modified Available
Form 2.3 Survey Form and Instruction Modified Available
Form 2 Survey Form and Instruction Modified Available
Form 1 Survey Form and Instruction Modified Available
Validation_20110103_Regulatory_Final_V1 b.docx Supplementary Document Uploaded 2011-01-27 Available
Lo-to-Hi Conversion Script 20101228_Regulatory Final_V1b.docx Supplementary Document Uploaded 2011-01-27 Available
Cover Memorandum 20110121.docx Justification for No Material/Nonsubstantive Change Uploaded 2011-01-27 Available
Birth Visit July Launch VIS 20100607.pdf Supplementary Document Uploaded 2010-06-07 Available
Pregnancy Visit 2 July Launch Visit Information Sheet 20100607.pdf Supplementary Document Uploaded 2010-06-07 Available
Pregnancy Visit 1 July Launch Visit Information Sheet 20100607.docx Supplementary Document Uploaded 2010-06-07 Available
Pre--pregnancy interview July Launch VIS 20100615.pdf Supplementary Document Uploaded 2010-06-15 Available
Birth Visit July Launch VIS 20100607.pdf Supplementary Document Uploaded 2010-06-07 Available
Pregnancy Visit 2 July Launch Visit Information Sheet 20100607.pdf Supplementary Document Uploaded 2010-06-07 Available
Pregnancy Visit 1 July Launch Visit Information Sheet 20100607.docx Supplementary Document Uploaded 2010-06-07 Available
Pre--pregnancy interview July Launch VIS 20100615.pdf Supplementary Document Uploaded 2010-06-15 Available
Birth Visit July Launch VIS 20100607.pdf Supplementary Document Uploaded 2010-06-07 Available
Pregnancy Visit 2 July Launch Visit Information Sheet 20100607.pdf Supplementary Document Uploaded 2010-06-07 Available
Pregnancy Visit 1 July Launch Visit Information Sheet 20100607.docx Supplementary Document Uploaded 2010-06-07 Available
Pre--pregnancy interview July Launch VIS 20100615.pdf Supplementary Document Uploaded 2010-06-15 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
193580 Two-Tier (High): Birth Visit Interview Form and Instruction ModifiedSurvey
193579 Two Tier (High): Pregnancy Visit 2 Interview Form and Instruction ModifiedSurvey
193578 Two Tier (High): Pregnancy Visit 1 Interview Form and Instruction ModifiedSurvey
193577 Two Tier (High): Women's Informed Consent Form Form and Instruction ModifiedConsent
193576 Two Tier (High): Pregnancy Probability Group Follow Up Script Form and Instruction ModifiedSurvey
193576 Two Tier (High): Pregnancy Probability Group Follow Up Script Form and Instruction ModifiedSurvey
193575 Two Tier (High): Pre-Pregnancy Interview Form and Instruction ModifiedSurvey
193574 Two Tier (High): Pregnancy Screening Form and Instruction ModifiedSurvey
193573 Two Tier (Low): Low-Intensity CATI Questionnaire (Birth-Related Activities) Form and Instruction ModifiedSurvey
193572 Two Tier (Low): Low-Intensity CATI Questionnaire (Pregnancy Activities) Form and Instruction ModifiedSurvey
193571 Two Tier (Low): Pregnancy Probability Group Follow Up Script Form and Instruction ModifiedSurvey
193571 Two Tier (Low): Pregnancy Probability Group Follow Up Script Form and Instruction ModifiedSurvey
193570 Two Tier (Low): Low-Intensity CATI Questionnaire (Age-Eligible Women) Form and Instruction ModifiedSurvey
193569 Two Tier (Low): Low-Intensity Consent Script Form and Instruction ModifiedConsent
193569 Two Tier (Low): Low-Intensity Consent Script Form and Instruction ModifiedConsent
193568 Two Tier (Low): Low-Intensity CATI Pregnancy Screener Form and Instruction ModifiedSurvey
193567 Enhanced Household: Birth Visit Interview Form and Instruction ModifiedSurvey
193566 Enhanced Household: Pregnancy Visit 2 Interview Form and Instruction ModifiedSurvey
193565 Enhanced Household: Pregnancy Visit 1 Interview Form and Instruction ModifiedSurvey
193564 Enhanced Household: Women's Informed Consent Form Form and Instruction ModifiedConsent
193563 Enhanced Household: Pregnancy Probability Group Follow Up Script Form and Instruction ModifiedSurvey
193563 Enhanced Household: Pregnancy Probability Group Follow Up Script Form and Instruction ModifiedSurvey
193562 Enhanced Household: Pre-pregnancy Interview Form and Instruction ModifiedSurvey
193561 Enhanced Household: Neighbor Report Form ModifiedForm
193560 Provider-Based: Birth Visit Interview Form and Instruction ModifiedSurvey
193559 Provider-Based: Pregnancy Visit 2 Interview Form and Instruction ModifiedSurvey
193558 Provider-Based: Pregnancy Visit 1 Interview Form and Instruction ModifiedSurvey
193557 Provider-Based: Women's Informed Consent Form Form and Instruction ModifiedConsent
193556 Provider-Based: Pregnancy Probability Group Follow Up Script Form and Instruction ModifiedSurvey
193556 Provider-Based: Pregnancy Probability Group Follow Up Script Form and Instruction ModifiedSurvey
193555 Provider-Based: Pre-Pregnancy Visit Form and Instruction ModifiedSurvey
193554 Provider-Based: Pregnancy Screening Form and Instruction ModifiedSurvey
193553 Provider-Based: Address Look-Up Instruction Modified
184272 Enhanced Household: Pregnancy Screening Form and Instruction ModifiedSurvey
184271 Enhanced Household: Household Enumeration Script Form and Instruction ModifiedSurvey

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2013 07/31/2013 07/31/2013
390,068 0 390,068
128,042 0 128,042
0 0 0





Reginfo record details
30
table that charts list of burden
IC Title Form No. Form Name
Enhanced Household: Birth Visit Interview 8
Enhanced Household: Household Enumeration Script 1
Enhanced Household: Neighbor Report 10
Enhanced Household: Pre-pregnancy Interview 4
Enhanced Household: Pregnancy Probability Group Follow Up Script 5.1, 5.2 ,  
Enhanced Household: Pregnancy Screening 2
Enhanced Household: Pregnancy Visit 1 Interview 6
Enhanced Household: Pregnancy Visit 2 Interview 7
Enhanced Household: Women's Informed Consent Form 3.1
Provider-Based: Address Look-Up
Provider-Based: Birth Visit Interview 8
Provider-Based: Pre-Pregnancy Visit 4
Provider-Based: Pregnancy Probability Group Follow Up Script 5.1, 5.2 ,  
Provider-Based: Pregnancy Screening 2.3
Provider-Based: Pregnancy Visit 1 Interview 6
Provider-Based: Pregnancy Visit 2 Interview 7
Provider-Based: Women's Informed Consent Form 3.1
Two Tier (High): Pre-Pregnancy Interview 4
Two Tier (High): Pregnancy Probability Group Follow Up Script 5.1, 5.2 ,  
Two Tier (High): Pregnancy Screening 2
Two Tier (High): Pregnancy Visit 1 Interview 6
Two Tier (High): Pregnancy Visit 2 Interview 7
Two Tier (High): Women's Informed Consent Form 3.1
Two Tier (Low): Low-Intensity CATI Pregnancy Screener 2.2
Two Tier (Low): Low-Intensity CATI Questionnaire (Age-Eligible Women) 9
Two Tier (Low): Low-Intensity CATI Questionnaire (Birth-Related Activities) 9
Two Tier (Low): Low-Intensity CATI Questionnaire (Pregnancy Activities) 9
Two Tier (Low): Low-Intensity Consent Script 3.2, 3.3 ,  
Two Tier (Low): Pregnancy Probability Group Follow Up Script 5.2, 5.1 ,  
Two-Tier (High): Birth Visit Interview 8

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 390,068 390,068 0 0 0 0
Annual Time Burden (Hours) 128,042 128,042 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No