Information Collection Request

Recruitment Strategy Substudy for the National Children's Study (NICHD)

ICR 201112-0925-004 · OMB 0925-0593 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 29.2 Survey Form and Instruction Modified Available
Form 29.1 Survey Form and Instruction Modified Available
Form 28.2 Survey Form and Instruction Modified Available
Form 28.1 Survey Form and Instruction Modified Available
Form 27.1 Survey Form and Instruction Modified Available
Form 27.2 Survey Form and Instruction Modified Available
Form 26.1 Survey Form and Instruction Modified Available
Form 25.2 Survey Form and Instruction Modified Available
Form 25.1 Survey Form and Instruction Modified Available
Form 24.1 Survey Form and Instruction Modified Available
Form 23.1 Survey Form and Instruction Modified Available
Form 22.1 Log Form and Instruction Modified Available
Form 21.1 Survey Form and Instruction Modified Available
Form 20.1 Survey Form and Instruction Modified Available
Form 19.1 Survey Form and Instruction Modified Available
Form 18.1 Consent Form and Instruction Modified Available
Form 17.1 Log Form and Instruction Modified Available
Form 16.2 Survey Form and Instruction Modified Available
Form 16.1 Survey Form and Instruction Modified Available
Form 15.2 Survey Form and Instruction Modified Available
Form 15.1 Survey Form and Instruction Modified Available
Form 14.1 Consent Form and Instruction Modified Available
Form 13.1 Survey Form and Instruction Modified Available
Form 12.1 Survey Form and Instruction Modified Available
Form 11.2 Survey Form and Instruction Modified Available
Form 11.1 Survey Form and Instruction Modified Available
Form 10.1 Survey Form and Instruction Modified Available
Form 9.2 Survey Form and Instruction Modified Available
Form 9.1 Survey Form and Instruction Modified Available
Form 8.1 Consent Form and Instruction Modified Available
Form 7.1 Consent Form and Instruction Modified Available
Form 6.1 Survey Form and Instruction Modified Available
Form 5.1 Survey Form and Instruction Modified Available
Form 4.1 Survey Form and Instruction Modified Available
Form 3.1 Survey Form and Instruction Modified Available
Form 2.3 Survey Form and Instruction Modified Repair queued
Form 2.2 Survey Form and Instruction Modified Available
Form 2.1 Survey Form and Instruction Modified Available
List of Instruments.docx Supplementary Document Uploaded 2011-12-21 Available
B.2.6 LOI2-PHYS-15 IRB Approval Letters.pdf Supplementary Document Uploaded 2011-12-21 Available
B.2.5 LOI2-PHYS-15 Protocol Summary.docx Supplementary Document Uploaded 2011-12-21 Available
B.2.3 LOI2-PHYS-15 Exemplar VIS NCS Vanguard.docx Supplementary Document Uploaded 2011-12-21 Available
B.2.2 LOI2-PHYS-15 Exemplar Consent Form.doc Supplementary Document Uploaded 2011-12-21 Available
B.2.1 LOI2-PHYS-15 Exemplar Recruitment Flyer.docx Supplementary Document Uploaded 2011-12-21 Available
B.1.8 LOI3-BIO-02-A Protocol Summary.pdf Supplementary Document Uploaded 2011-12-21 Available
B.1.6 LOI3-BIO-02 Exemplar Phone Script.docx Supplementary Document Uploaded 2011-12-21 Available
B.1.5 LOI3-BIO-05 Collection Inst.pdf Supplementary Document Uploaded 2011-12-21 Available
B.1.4 LOI3-BIO-02-C Exemplar VIS NCS Vanguard.docx Supplementary Document Uploaded 2011-12-21 Available
B.1.3 LOI3-BIO-02 Exemplar Consent.docx Supplementary Document Uploaded 2011-12-21 Available
B.1.1 LOI3-BIO-02 Recruitment Flyer.docx Supplementary Document Uploaded 2011-12-21 Available
Cover Memorandum 20111221.docx Justification for No Material/Nonsubstantive Change Uploaded 2011-12-21 Available
Note to File - Birth Visit - Umbilical Cord Blood Collection.docx Supplementary Document Uploaded 2011-04-08 Available
TWF Distrib 20110621.doc Supplementary Document Uploaded 2011-07-01 Available
VBD Distrib 20110621.doc Supplementary Document Uploaded 2011-07-01 Available
TWQ Distrib 20110621.doc Supplementary Document Uploaded 2011-07-01 Available
Note to File - Biological and Environmental Sample Collection.docx Supplementary Document Uploaded 2011-04-08 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
193580 Formative - Developmental Instruction Modified
193579 24-Month Maternal Phone Call (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
193579 24-Month Maternal Phone Call (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
193578 18-Month Maternal Phone Call (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
193578 18-Month Maternal Phone Call (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
193577 12-Month Visit Interview (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
193577 12-Month Visit Interview (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
193576 9-Month Phone Call (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
193575 6-Month Visit Interview (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
193575 6-Month Visit Interview (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
193574 3-Month Phone Call (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
193573 Low-Intensity Questionnaire (Child-focus) (TT-LI) Form and Instruction ModifiedSurvey
193572 Infant Feeding Log (PB, EH, TT-HI) Form and Instruction ModifiedLog
193571 Low-Intensity Questionnaire (Birth focus) (TT-LI) Form and Instruction ModifiedSurvey
193570 Birth Visit Interview (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
193569 Father Interview (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
193568 Father Informed Consent Form (PB, EH, TT-HI) Form and Instruction ModifiedConsent
193567 Pregnancy Health Care Log (PB, EH, TT-HI) Form and Instruction ModifiedLog
193566 Pregnancy Visit 2 Interview (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
193566 Pregnancy Visit 2 Interview (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
193565 Pregnancy Visit 1 Interview (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
193565 Pregnancy Visit 1 Interview (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
193564 Pregnant Women's Informed Consent Form (PB, EH, TT-HI) Form and Instruction ModifiedConsent
193563 Validation Script (PB, EH, TT-HI, TT-LI) Form and Instruction ModifiedSurvey
193562 Low-Intensity Questionnaire (Non- and Pregnant) (TT-LI) Form and Instruction ModifiedSurvey
193561 Pregnancy Probability Group Follow Up Script (PB, EH, TT-HI, TT-LI) Form and Instruction ModifiedSurvey
193561 Pregnancy Probability Group Follow Up Script (PB, EH, TT-HI, TT-LI) Form and Instruction ModifiedSurvey
193560 Biological and Environmental Sample Collection (PB, EH, TT-HI) Instruction Modified
193560 Biological and Environmental Sample Collection (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
193559 Pre-Pregnancy Interview (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
193559 Pre-Pregnancy Interview (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
193558 Non-pregnant Women's Informed Consent (PB, EH, TT-HI) Form and Instruction ModifiedConsent
193557 Low-Intensity Consent Script (TT-LI) Form and Instruction ModifiedConsent
193556 Pregnancy Screener (TT-LI, TT-HI) Form and Instruction ModifiedSurvey
193555 Low-Intensity Invitation to High-Intensity Script (TT-HI) Form and Instruction ModifiedSurvey
193554 Household Enumeration Instrument (EH) Form and Instruction ModifiedSurvey
193553 Healthcare Provider Questionnaire (PB) Form and Instruction ModifiedSurvey
184272 Pregnancy Screener (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
184272 Pregnancy Screener (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
184272 Pregnancy Screener (PB, EH, TT-HI) Form and Instruction ModifiedSurvey
184271 Address Lookup Tool (PB) Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2013 07/31/2013 07/31/2013
455,206 0 455,206
159,966 0 159,966
0 0 0





Reginfo record details
30
table that charts list of burden
IC Title Form No. Form Name
12-Month Visit Interview (PB, EH, TT-HI) 27.2, 27.1 ,  
18-Month Maternal Phone Call (PB, EH, TT-HI) 28.1, 28.2 ,  
24-Month Maternal Phone Call (PB, EH, TT-HI) 29.1, 29.2 ,  
3-Month Phone Call (PB, EH, TT-HI) 24.1
6-Month Visit Interview (PB, EH, TT-HI) 25.1, 25.2 ,  
9-Month Phone Call (PB, EH, TT-HI) 26.1
Address Lookup Tool (PB)
Biological and Environmental Sample Collection (PB, EH, TT-HI) 10.1
Birth Visit Interview (PB, EH, TT-HI) 20.1
Father Informed Consent Form (PB, EH, TT-HI) 18.1
Father Interview (PB, EH, TT-HI) 19.1
Formative - Developmental
Healthcare Provider Questionnaire (PB) 3.1
Household Enumeration Instrument (EH) 4.1
Infant Feeding Log (PB, EH, TT-HI) 22.1
Low-Intensity Consent Script (TT-LI) 7.1
Low-Intensity Invitation to High-Intensity Script (TT-HI) 5.1
Low-Intensity Questionnaire (Birth focus) (TT-LI) 21.1
Low-Intensity Questionnaire (Child-focus) (TT-LI) 23.1
Low-Intensity Questionnaire (Non- and Pregnant) (TT-LI) 12.1
Non-pregnant Women's Informed Consent (PB, EH, TT-HI) 8.1
Pre-Pregnancy Interview (PB, EH, TT-HI) 9.1, 9.2 ,  
Pregnancy Health Care Log (PB, EH, TT-HI) 17.1
Pregnancy Probability Group Follow Up Script (PB, EH, TT-HI, TT-LI) 11.1, 11.2 ,  
Pregnancy Screener (PB, EH, TT-HI) 2.1, 2.2, 2.3 ,   ,  
Pregnancy Screener (TT-LI, TT-HI) 6.1
Pregnancy Visit 1 Interview (PB, EH, TT-HI) 15.1, 15.2 ,  
Pregnancy Visit 2 Interview (PB, EH, TT-HI) 16.1, 16.2 ,  
Pregnant Women's Informed Consent Form (PB, EH, TT-HI) 14.1
Validation Script (PB, EH, TT-HI, TT-LI) 13.1

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 455,206 455,206 0 0 0 0
Annual Time Burden (Hours) 159,966 159,966 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No