List of Instruments

OMB Collection #: 0925-0593

Expiration Date: 7/31/2013

README – POSTING INSTRUCTIONS

NOTE: File titles include the date of submission and formative research project number (when applicable)

FOR POSTING UNDER IC #10

File #	File Title	Instrument Title	Document Type	NOTES
B.1	TWF Part SAQ	Environmental Tap Water Pharmaceutical (TWF) Participant Collect SAQ	Form and Instruction
B.2	TWQ Part SAQ	Environmental Tap Water Pesticide (TWQ) Participant Collect SAQ	Form and Instruction
B.3	VBD Part SAQ	Environmental Vacuum Bag Dust (VBD) Participant Collect SAQ	Form and Instruction
B.7	TWF Distrib	Environmental Tap Water Pharmaceutical (TWF) Sample Distribution Script	Supplementary / Other
B.8	TWQ Distrib	Environmental Tap Water Pesticide (TWQ) Sample Distribution Script	Supplementary / Other
B.9	VBD Distrib	Environmental Vacuum Bag Dust (VBD) Sample Distribution Script	Supplementary / Other

FOR POSTING UNDER IC #30

File #	File Title	Instrument Title	Document Type	NOTES
N/A	Note To File – Formative Research (updated 20110617)	Note To File – Formative Research	Instruction	Replaces current note to file
C2.3	Exemplar Questionnaire	Exemplar Demographic Questionnaire (for Non-NCS Vanguard Study Participants)	Instruction	Supports LOI3-PHYS-02
C2.4	Measurement Form	LOI3-PHYS-02 Exemplar Measurement Form	Instruction	Supports LOI3-PHYS-02
C3.2	Screening	LOI2-PHYS-01 Exemplar Screening Questionnaire	Instruction	Supports LOI3-PHYS-01
C3.4	Contact Info	Exemplar Contact Information Sheet (for Non-NCS Vanguard Study Participants) – LOI3-PHYS-01	Instruction	Supports LOI3-PHYS-01
C3.6	Questionnaire	LOI2-PHYS-01 Exemplar Demographic and Health Questionnaire	Instruction	Supports LOI3-PHYS-01
C3.7	Visit Screen	LOI2-PHYS-01 Exemplar Health Screen	Instruction	Supports LOI3-PHYS-01
C3.8	Exit Survey	LOI2-PHYS-01 Exemplar Parental Exit Survey	Instruction	Supports LOI3-PHYS-01
C4.2	NCS ASA24 Protocol (Placeholder for web survey)	NCS ASA24 Protocol - LOI2-QUEX-14	Instruction	Supports LOI2-QUEX-14 Includes screenshots
C4.4	Food Record	Food Record Form - LOI2-QUEX-14	Instruction	Supports LOI2-QUEX-14
C4.7	NCS FFQ	NCS Food Frequency Questionnaire - LOI2-QUEX-14	Instruction	Supports LOI2-QUEX-14
C4.8	Acculturation Instrument	Acculturation and Food Programs Instrument (Pregnant Women) - LOI2-QUEX-14	Instruction	Supports LOI2-QUEX-14
C4.9	Acceptability Questionnaire (Pregnant Women)	The ASA-24 Acceptability Questionnaire (Initial) - LOI2-QUEX-14	Instruction	Supports LOI2-QUEX-14
C4.10	The Acceptability Questionnaire_2	The ASA-24 Acceptability Questionnaire (Second) - LOI2-QUEX-14	Instruction	Supports LOI2-QUEX-14

FOR POSTING UNDER “FILES” TAB

File #		Instrument Title	Document Type	NOTES
N/A	Cover Memorandum Requesting Nonsubstantive Change 20110621	Cover Memorandum	Justification for No Material/Nonsubstantive Change
B.4	TWF Part Ins	Environmental Tap Water Pharmaceutical (TWF) Participant Collect Instructions	Supplementary / Other
B.5	TWQ Part Ins	Environmental Tap Water Pesticide (TWQ) Participant Collect Instructions	Supplementary / Other
B.6	VBD Part Ins	Environmental Vacuum Bag Dust (VBD) Participant Collect Instructions	Supplementary / Other
C1.1	Consent Form	Exemplar Consent Form – LOI2-BIO-18	Supplementary / Other	Supports LOI2-BIO-18
C1.2	Birth Visit Information Sheet	Visit Information Sheet – Birth Visit & Follow-up Visit – LOI2-BIO-18	Supplementary / Other	Supports LOI2-BIO-18
C2.1	Flyer	Exemplar Flyer (for Non-NCS Vanguard Study Participants) – LOI3-PHYS-02	Supplementary / Other	Supports LOI3-PHYS-02
C2.2	Exemplar Consent	Exemplar Consent Form (for Non-NCS Vanguard Study Participants) – LOI3-PHYS-02	Supplementary / Other	Supports LOI3-PHYS-02
C2.5	VIS	Visit Information Sheet - LOI3-PHYS-02	Supplementary / Other	Supports LOI3-PHYS-02
C3.1	Exemplar Flyer	Exemplar Flyer (for Non-NCS Vanguard Study Participants) – LOI3-PHYS-01	Supplementary / Other	Supports LOI3-PHYS-01
C3.3	Informed Consent	Exemplar Consent Form (for Non-NCS Vanguard Study Participants) – LOI3-PHYS-01	Supplementary / Other	Supports LOI3-PHYS-01
C3.5	Exemplar VIS	Supplemental Visit Information Sheet (for NCS Vanguard Study Participants) – LOI3-PHYS-01	Supplementary / Other	Supports LOI3-PHYS-01
C4.1	Exemplar Consent Form	Exemplar Consent Form - LOI2-QUEX-14	Supplementary / Other	Supports LOI2-QUEX-14
C4.3	ASA24 Instructions	ASA24 Instructions - LOI2-QUEX-14	Supplementary / Other	Supports LOI2-QUEX-14
C4.5	Food Portion Guide	Food Portion Guide - LOI2-QUEX-14	Supplementary / Other	Supports LOI2-QUEX-14
C4.6	Food Diary Instructions for Parent_MOM	Food Diary Instructions - LOI2-QUEX-14	Supplementary / Other	Supports LOI2-QUEX-14

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