Itemized Burden Table

OMB # 0925-0593

Expiration Date: 7/31/2013

Phase II

Itemized Burden Table

Table A.12. Estimated Hour Burden and Cost for the Recruitment Substudy Respondents, Postnatal to Age 2, Phases 1 and 2

Activity	Type of Respondent	Number of Respondents	Responses per Respondent	Hours per Response	Annual Hour Burden	Annual Respondent Cost
Screening Activities
Address Lookup Tool (PB)	Age-Eligible Women	7,500	1	0.10	750	$7,500
Pregnancy Screener (PB, EH, TT-HI)	Age-Eligible Women	68,538	1	0.42	28,786	$287,860
Healthcare Provider Questionnaire (PB)	Healthcare Providers	600	1	0.16	96	$960
Household Enumeration Instrument (EH)	HH Reporters	120,000	1	0.33	39,600	$396,000
Low-intensity Invitation to High-intensity Script (TT-HI)	Age-Eligible Women	15,840	1	0.25	3,960	$39,600
Pregnancy Screener (TT-LI, TT-HI)	Age-Eligible Women	48,000	1	0.35	16,800	$168,000
Low-Intensity Consent Script (TT-LI)	Age-Eligible Women	28,800	1	0.33	9,504	$95,040
Preconception Activities
Non-pregnant Women's Informed Consent (PB, EH, TT-HI)	Age-Eligible Women	1,825	1	0.50	913	$9,125
Pre-Pregnancy Interview (PB, EH, TT-HI)	Age-Eligible Women	1,095	1	0.75	821	$8,213
Biological and Environmental Sample Collection - Preconception (PB, EH, TT-HI)	Age-Eligible Women	986	1	0.25	246	$2,464
Pregnancy Probability Group Follow Up Script (PB, EH, TT-HI, TT-LI)	Age-Eligible Women	11,152	6	0.10	6691	$66,912
Low-intensity Questionnaire (Non-Pregnant) (TT-LI)	Age-Eligible Women	10,057	1	0.50	5,029	$50,285
Validation Script (PB, EH, TT-HI, TT-LI)	Age-Eligible Women	3,625	1	0.08	290	$2,900
Pregnancy Activities
Pregnant Women's Informed Consent Form (PB, EH, TT-HI)	Pregnant Women	11,767	1	0.50	5,884	$58,835
Low-intensity Questionnaire (Found Pregnant) (TT-LI)	Pregnant Women	518	1	0.50	259	$2,590
Activity	Type of Respondent	Number of Respondents	Responses per Respondent	Hours per Response	Annual Hour Burden	Annual Respondent Cost
Pregnancy Activities (Cont.)
Pregnancy Visit 1 Interview (PB, EH, TT-HI)	Pregnant Women	5,110	1	1.00	5,110	$51,100
Biological and Environmental Sample Collection - Pregnancy (PB, EH, TT-HI)	Pregnant Women	8,311	1	0.25	2,078	$20,778
Pregnancy Visit 2 Interview (PB, EH, TT-HI)	Pregnant Women	5,110	1	0.75	3,833	$38,325
Pregnancy Health Care Log (PB, EH, TT-HI)	Pregnant Women	4,088	1	0.33	1349	$13,490
Father Informed Consent Form (PB, EH, TT-HI)	Alternate Caregiver	4,088	1	0.50	2044	$20,440
Father Interview (PB, EH, TT-HI)	Alternate Caregiver	2,453	1	0.25	613	$6,132
Birth-Related Activities
Birth Visit Interview (PB, EH, TT-HI)	Mother/Baby	2,672	1	0.40	1,069	$10,688
Low-intensity Questionnaire (Birth-focus) (TT-LI)	Mother/Baby	1,296	1	0.50	648	$6,480
Postnatal Activities
Infant Feeding Log (PB, EH, TT-HI)	Mother/Baby	2,592	1	0.33	855	$8,553
Low-intensity Questionnaire (Child-focus) (TT-LI)	Mother/Baby	1,147	4	0.50	2,295	$22,947
3-Month Phone Call (PB, EH, TT-HI)	Mother/Baby	2,592	1	0.33	855	$8,553
6-Month Visit Interview (PB, EH, TT-HI)	Mother/Baby	2,514	1	0.50	1,257	$12,570
9-Month Phone Call (PB, EH, TT-HI)	Mother/Baby	2,439	1	0.17	415	$4,146
12-Month Visit Interview (PB, EH, TT-HI)	Mother/Baby	2,366	1	0.50	1,183	$11,828
18-Month Maternal Phone Call (PB, EH, TT-HI)	Mother/Baby	2,247	1	0.50	1,124	$11,236
24-Month Maternal Phone Call (PB, EH, TT-HI)	Mother/Baby	2,135	1	0.50	1,067	$10,674
Formative Research
Formative - Developmental	14,542					$145,422
Grand Total, Recruitment Substudy		381,462			145,422	1,454,223
Total, Formative Research					14,542	$145,422
Grand Total		381,462			159,965	1,599,645