Adult Study Participants (baseline only + 1 retest)

NIH Toolbox for Assessment of Neurological and Behavioral Function (NIA)

OMB: 0925-0638

IC ID: 197918

Documents and Forms
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Instruction
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Information Collection (IC) Details

View Information Collection (IC)

Adult Study Participants (baseline only + 1 retest)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 2 Hearing Handicap Inventory (HHI) Attach 2 Hearing Handicap Inventory.pdf Yes Yes Fillable Fileable
Form and Instruction 1 Automated Audiometry from the NIH Toolbox (AANT) Attach 1 Automated Audiometry for the NIH Toolbox (AANT).pdf Yes Yes Fillable Fileable
Form and Instruction 6 University of Penn Smell Identification Attach 6 University of Pennsylvania Smell Identification Test (UPSIT).pdf Yes Yes Fillable Fileable
Form and Instruction 3 Words in Noise Attach 3 Words-In-Noise Test (WIN).pdf Yes Yes Fillable Fileable
Form and Instruction 4 Ordor Identification Attach 4 Odor Identification Ages 10-85.pdf Yes Yes Fillable Fileable
Form and Instruction 10 PA Ages 18-85 Attach 10 Pain Assessment Ages 18-85.pdf Yes Yes Fillable Fileable
Form and Instruction 11 Sucrose Preference Test Attach 11 Sucrose Preference Test.pdf Yes Yes Fillable Fileable
Form and Instruction 12 Toolbox Taste Test Attach 12 Toolbox Taste Test.pdf Yes Yes Fillable Fileable
Form and Instruction 13 Dynamic Visual Acuity (DVA) Attach 13 Dynamic Visual Acuity (DVA).pdf No Yes Fillable Fileable
Form and Instruction 14 Vision Health Related QOL Survey Attach 14 Vision Health-Related Quality of Life Survey.pdf Yes Yes Fillable Fileable
Form and Instruction 15 Brief Kinesthesia Test Attach 15 Brief Kinesthesia Test.pdf Yes Yes Fillable Fileable
Form and Instruction 27 Handedness Assessment Attach 27 Determining Handedness.pdf Yes Yes Fillable Fileable
Form and Instruction 17 Tactile Discrimination Test Attach 17 Tactile Discrimination Test.pdf Yes Yes Fillable Fileable
Form and Instruction 18 Dimensional Card Change Sort Attach 18 Dimensional Change Card Sort.pdf Yes Yes Fillable Fileable
Form and Instruction 19 Bateria III Picture Vocabulary (Spanish only) Attach 19 Bateria III Picture Vocabulary.pdf Yes Yes Fillable Fileable
Form and Instruction 20 Imitation Based Assessment of Memory Attach 20 Flanker.pdf Yes Yes Fillable Fileable
Form and Instruction 22 List Sorting Attach 22 List Sorting.pdf Yes Yes Fillable Fileable
Form and Instruction 23 Oral Symbol Digit Modalities Attach 23 Oral Symbol Digit Modalities Test.pdf Yes Yes Paper Only
Form and Instruction 24 Pattern Comparison Attach 24 Pattern Comparison.pdf Yes Yes Fillable Fileable
Form and Instruction 26 Reading Recognition Attach 26 Reading Recognition.pdf Yes Yes Fillable Fileable
Form and Instruction 28 Vocabulary Comprehension Attach 28 Vocabulary Comprehension.pdf Yes Yes Fillable Fileable
Form and Instruction 29 Word Accentuation (Spanish only) Attach 29 Spanish Word Accentuation Test.pdf Yes Yes Fillable Fileable
Instruction Attach 30 Instructions for Emotional Health Questionnaire.pdf Yes Yes Fillable Fileable
Form and Instruction 31 Emotional Health Questionaire Attach 31 Emotional Health Questionnaires for Toolbox.xlsx Yes Yes Fillable Fileable
Form and Instruction 32 Supplemental Emotional Health Questionaire Attach 32 Supplemental Emotional Health Questionnaires.xls Yes Yes Fillable Fileable
Form and Instruction 33 Dexterity 9-hole Pegboard Attach 33 9 Hole Pegboard.pdf Yes Yes Fillable Fileable
Form and Instruction 34 Endurance 2-Minute Walk Test Attach 34 Endurance 2 Minute Walk Test (2MWT).pdf Yes Yes Fillable Fileable
Form and Instruction 35 Locomotion 4-meter Walk Test Attach 35 Locomotion 4 Meter Walk Test.pdf Yes Yes Fillable Fileable
Form and Instruction 36 Grip Strength Dynamometry Attach 36 Grip Strength Dynamometry.pdf Yes Yes Fillable Fileable
Form and Instruction 37 Strength Knee Extension Attach 37 Strength Knee Extension.pdf Yes Yes Fillable Fileable
Form and Instruction 38 Balance Accelerometer Measure Attach 38 Balance Accelerometer Measure (BAM).pdf Yes Yes Fillable Fileable
Form and Instruction 39 Initial Adult Questionaire Attach 39 Initial Questionnaire - Adult.pdf Yes Yes Fillable Fileable
Form and Instruction 41 Additional Somatosensation Questions Attach 41 Additional Somatosensation Questions.pdf Yes Yes Fillable Fileable
Form and Instruction 42 Additional Audition Olfaction Taste Attach 42 Additional Audition Olfaction Taste Questions.pdf Yes Yes Fillable Fileable
Form and Instruction 43 Cognition Information Form Attach 43 Cognition Information Form.pdf Yes Yes Fillable Fileable
Form and Instruction 44 Health Care Access and Utilization Attach 44 Health Care Access and Utilization.pdf Yes Yes Fillable Fileable
Form and Instruction 45 Instrumental Activities of Daily Living Attach 45 Instrumental Activities of Daily Living (IADL) - Adults.pdf Yes Yes Fillable Fileable
Form and Instruction 46 Applied Cognition Adult Attach 46 Applied Cognition - Adults.xlsx Yes Yes Fillable Fileable
Form and Instruction 52 PROMIS 29 Participant Attach 52 PROMIS 29 - Participant.pdf Yes Yes Fillable Fileable
Form and Instruction 57 EtOH (Alcohol) Questionaire Attach 57 EtOH Questionnaire.pdf No No Fillable Fileable
Form and Instruction 58 Education Adult Self-Report Attach 58 Education Adult Self-Report.pdf Yes Yes Fillable Fileable
Form and Instruction 59 Education Proxy Report for Children Attach 59 Education Proxy Report for Children.pdf Yes Yes Fillable Fileable
Form and Instruction 55 Text Anxiety Scale Attach 55 Test Anxiety Scale (TAS).pdf Yes Yes Fillable Fileable
Form and Instruction 56 Falls Efficscy Scale-International Attach 56 Falls Efficacy Scale-International (Short FES-I).pdf Yes Yes Fillable Fileable

Health Health Care Services

Clinical, Basic, and Population-based Research Studies of the National Institutes of Health (NIH)   64 FR 66969

3,900 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 5,850 0 5,850 0 0 0
Annual IC Time Burden (Hours) 17,550 0 17,550 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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