79.2 Survey

OMB #: 0925-0593

Expiration Date: 07/31/2013

18-Month SAQ, Phase II

Event Name(s):

18-Month SAQ (EH, PB, HI)

Instrument Name(s) and Versions:

18-Month SAQ (EH, PB, HI) – 1.0

Recruitment Groups:

Enhanced Household, Provider-Based, High Intensity

Ages and Stages III Questionnaire

Paul H. Brookes Publishing Co, Inc.

Copyrighted material available from the publisher upon request

Public reporting burden for this collection of information is estimated to average 10 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.