Parent Proxies (baseline only + retest)

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

OMB: 0925-0638

IC ID: 197920

Documents and Forms
Document Name
Document Type
Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Parent Proxies (baseline only + retest)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Attach 30 Instructions for Emotional Health Questionnaire.pdf Yes Yes Paper Only
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 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 27 Handedness Assessment Attach 27 Determining Handedness.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 48 Pediatric Perceived Cognitive Proxy Attach 48 Pediatric Perceived Cognitive Function (PCF) - Proxy.pdf Yes Yes Fillable Fileable
Form and Instruction 51 Pediatric Funtional Assessment of Chronic Illness Therapy Fatigue Attach 51 Pediatric Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F).pdf Yes Yes Fillable Fileable
Form and Instruction 53 School Performance and Activities Attach 53 School Performance and Activities.pdf Yes Yes Fillable Fileable
Form and Instruction 54 Socio-demographic form Attach 54 Sociodemographic Form- Parent.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 40 Initial Child/Proxy Questionaire Attach 40 Initial Questionnaire-Proxy and Child.pdf Yes Yes Fillable Fileable
Form and Instruction 7 Pain Assessment Ages 3-7 Attach 7 Pain Asssessment Proxy Ages 3-7.pdf Yes Yes Fillable Printable
Form and Instruction 8 Pain Assessment Ages 8-12 Attach 8 Pain Assessment Ages 8-12.pdf Yes Yes Fillable Fileable
Form and Instruction 9 Pain Assessment Ages 8-12 Attach 9 Pain Assessment Ages 13-17.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

4,500 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 6,750 0 6,750 0 0 0
Annual IC Time Burden (Hours) 3,375 0 3,375 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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