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 #20

File #	File Title	Instrument Title	Document Type	NOTES
A.1.1	Birth Visit Instrument (EH, PB, HI)	Birth Instrument for Enhanced Household, Provider-Based, and High Intensity	Form and Instruction	Replaces current instrument

FOR POSTING UNDER IC #21

File #	File Title	Instrument Title	Document Type	NOTES
A.1.2	Birth Visit Instrument Two-Tier Low Intensity	Birth Visit Instrument Two Tier Low Intensity	Form and Instruction	Replaces current instrument

FOR POSTING UNDER IC #30

File #	File Title	Instrument Title	Document Type	NOTES
N/A	Note To File – Formative Research (updated 20110909)	Note To File – Formative Research	Instruction	Replaces current note to file
B.1.2	Burden 900 B.1.2 LOI3-BIO-02 Exemplar Screening Interview	B.1.2. Exemplar Screening Interview	Instruction	Supports LOI3-BIO-02 and LOI3-BIO-05
B.1.7	Burden 900 B.1.7 LOI3-BIO-02 Exemplar Interview	B.1.7 Exemplar Interview	Instruction	Supports LOI3-BIO-02 and LOI3-BIO-05
B.2.4	Burden 225 B.2.4 LOI2-PHYS-15 Exemplar Participant Experience Survey	B.2.4 Exemplar Participant Experience Survey	Instruction	Supports LOI2-PHYS-15
B.3.2	Burden 2800 B.3.2 LOI3-QUEX-01 Exemplar Screening Tool	B.3.2 Exemplar Screening Tool	Instruction	Supports LOI3-QUEX-01
B.3.4	Burden 2800 B.3.4 LOI3-QUEX-01 Participant Contact Information Sheet	B.3.4 Exemplar Participant Contact Information Sheet	Instruction	Supports LOI3-QUEX-01
B.3.5	Burden 2800 B.3.5 LOI3-QUEX-01 Enrollment Medical Record Abstraction Form	B.3.5 Exemplar Medical Record Abstraction Form	Instruction	Supports LOI3-QUEX-01
B.3.6	Burden 2800 B.3.6 LOI3-QUEX-01 Exemplar Demographic and Health Survey	B.3.6 Exemplar Demographics and Health Interview	Instruction	Supports LOI3-QUEX-01
B.3.7	Burden 2800 B.3.7 LOI3-QUEX-01 Visit 1 Stress Questionnaire	B.3.7 Visit 1 Stress Questionnaire	Instruction	Supports LOI3-QUEX-01
B.3.8	Burden 2800 B.3.8 LOI3-QUEX-01 Take Home Packet	B.3.8 Take Home Packet	Instruction	Supports LOI3-QUEX-01
B.3.9	Burden 2800 B.3.9 LOI3-QUEX-01 Visit 2 Stress Questionnaire	B.3.9. Visit 2 Stress Questionnaire	Instruction	Supports LOI3-QUEX-01
B.3.11	Burden 2800 B.3.11 LOI3-QUEX-01 Postpartum Abstraction Form	B.3.11 Exemplar Postpartum Medical Record Abstraction Form	Instruction	Supports LOI3-QUEX-01
B.4.3	Burden 324 B.4.3 LOI2-QUEX-5 Exemplar Telephone Screener	B.4.3 Telephone Screener	Instruction	Supports LOI2-QUEX-5
B.4.4	Burden 324 B.4.4 LOI2-QUEX-5 Assessment Description Bayley-3 Short form	B.4.4 Assessment Description	Instruction	Supports LOI2-QUEX-5 Copyrighted material
B.5.2	Burden 2178 B.5.2 LOI2-QUEX-13 Cognitive Interview Phone Screen Script	B.5.2. Exemplar Cognitive Interview Phone Screener Script	Instruction	Supports LOI2-QUEX-13
B.5.4	Burden 2178 B.5.4 LOI2-QUEX-13 Cognitive Interviewing Guide	B.5.4 Exemplar Cognitive Interviewing Guide	Instruction	Supports LOI2-QUEX-13
B.5.5	Burden 2178 B.5.5 LOI2-QUEX-13 Interview Phone Screen Script	B.5.5 Exemplar Interview Phone Screener Script	Instruction	Supports LOI2-QUEX-13
B.5.8	Burden 2178 B.5.8 LOI2-QUEX-13 Exemplar Interview	B.5.8 Exemplar Interview	Instruction	Supports LOI2-QUEX-13

FOR POSTING UNDER “FILES” TAB

File #		Instrument Title	Document Type	NOTES
N/A	Cover Memorandum 20110909	Cover Memorandum	Justification for No Material/Nonsubstantive Change
N/A	READ ME – POSTING INSTRUCTIONS (OMB #0925-0593 Expiration Date 7 31 2013)_20110909	List of Instruments
B.1.1	B.1.1 LOI3-BIO-02 Recruitment Flyer	B.1.1 Exemplar Recruitment Flyer	Supplementary / Other	Supports LOI3-BIO-02 and-05
B.1.3	B.1.3 LOI3-BIO-02 Exemplar Consent	B.1.3 Exemplar Breast Milk Collection Consent Form (for Non-NCS Vanguard Study Participants)	Supplementary / Other	Supports LOI3-BIO-02 and-05
B.1.4	B.1.4 LOI3-BIO-02-C Exemplar VIS NCS Vanguard	B.1.4 NCS Visit Information Sheet (for NCS Vanguard Study Participants)	Supplementary / Other	Supports LOI3-BIO-02 and-05
B.1.5	B.1.5 LOI3-BIO-05 Collection Inst	B.1.5 Exemplar Collection Instructions	Supplementary / Other	Supports LOI3-BIO-02 and-05
B.1.6	B.1.6 LOI3-BIO-02 Exemplar Phone Script	B.1.6 Exemplar Phone Script to Schedule Study Visits	Supplementary / Other	Supports LOI3-BIO-02 and-05
B.1.8	B.1.8 LOI3-BIO-02-A Protocol Summary	B.1.8 Protocol Summary (Excerpted from local IRB protocol	Supplementary / Other	Supports LOI3-BIO-02 and-05
B.2.1	B.2.1 LOI2-PHYS-15 Exemplar Recruitment Flyer	B.2.1 Exemplar Recruitment Flyer (Non-NCS Vanguard Study Participants)	Supplementary / Other	Supports LOI2-PHYS-15
B.2.2	B.2.2 LOI2-PHYS-15 Exemplar Consent Form	B.2.2 Exemplar Dysmorphology Assessment Consent Form (for Non-NCS Vanguard Study Participants)	Supplementary / Other	Supports LOI2-PHYS-15
B.2.3	B.2.3 LOI2-PHYS-15 Exemplar VIS NCS Vanguard	B.2.3 NCS Visit Information Sheet (for NCS Vanguard Study Participants)	Supplementary / Other	Supports LOI2-PHYS-15
B.2.5	B.2.5 LOI2-PHYS-15 Protocol Summary	B.2.5 Protocol Summary (Excerpted from local IRB protocol)	Supplementary / Other	Supports LOI2-PHYS-15
B.2.6	B.2.6 LOI2-PHYS-15 IRB Approval Letters	B.2.6 Protocol Summary (Excerpted from local IRB protocol)	Supplementary / Other	Supports LOI2-PHYS-15
B.3.1	B.3.1 LOI3-QUEX-01 Exemplar Recruitment Flyer	B.3.1 Exemplar Recruitment Flyer	Supplementary / Other	Supports LOI3-QUEX-01
B.3.3	B.3.3 LOI3-QUEX-01 Exemplar Consent Form	B.3.3 Exemplar Stress and Cortisol Consent Form	Supplementary / Other	Supports LOI3-QUEX-01
B.3.10	B.3.10 LOI3-QUEX-01 SLES Checklist	B.3.10 Stressful Life Event Schedule (SLES) Checklist	Supplementary / Other	Supports LOI3-QUEX-01
B.3.12	B.3.12 LOI3-QUEX-01 Protocol Summary Excerpt	B.3.12 Protocol Summary (Excerpted from local IRB Protocol)	Supplementary / Other	Supports LOI3-QUEX-01
B.3.13	B.3.13 LOI3-QUEX-01 IRB Approval Letters	B.3.13 IRB Approval Letter	Supplementary / Other	Supports LOI3-QUEX-01
B.4.1	B.4.1 LOI2-QUEX-5 Exemplar Recruitment Flyer	B.4.1 Exemplar Flyer	Supplementary / Other	Supports LOI2-QUEX-5
B.4.2	B.4.2 LOI2-QUEX-5 Exemplar Consent	B.4.2 Exemplar Consent	Supplementary / Other	Supports LOI2-QUEX-5
B.4.5	B.4.5 LOI2-QUEX-05 Protocol Summary	B.4.5 Protocol Summary (excerpted from local IRB protocol)	Supplementary / Other	Supports LOI2-QUEX-5
B.4.6	B.4.6 LOI2-QUEX-05 IRB Approval Letters	B.4.6 IRB Approval Letter	Supplementary / Other	Supports LOI2-QUEX-5
B.5.1	B.5.1 LOI2-QUEX-13 Exemplar Recruitment Flyer	B.5.1 Exemplar Recruitment Flyer	Supplementary / Other	Supports LOI2-QUEX-13
B.5.3	B.5.3 LOI2-QUEX-13 Consent for Cognitive Interview	B.5.3 Exemplar Consent for Cognitive Interview	Supplementary / Other	Supports LOI2-QUEX-13
B.5.6	B.5.6 LOI2-QUEX-13 Consent First Time Moms	B.5.6 Exemplar Consent for First-Time Mothers	Supplementary / Other	Supports LOI2-QUEX-13
B.5.7	B.5.7 LOI2-QUEX-13 Consent Current Moms	B.5.7 Exemplar Consent for Mothers with Children Age 0-5	Supplementary / Other	Supports LOI2-QUEX-13
B.5.9	B.5.9 LOI2-QUEX-13 Protocol Summary	B.5.9 Protocol Summary (Excerpted from Local IRB Package)	Supplementary / Other	Supports LOI2-QUEX-13
B.5.10	B.5.10 LOI2-QUEX-13 IRB Approval Letter	B.5.10 IRB Approval Letters	Supplementary / Other	Supports LOI2-QUEX-13

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