Information Collection Request

Provider-Based Sampling Feasibility Study for the Vanguard (Pilot) Study and Data Collection Updates for the National Children's Study (NICHD)

ICR 201205-0925-002 · OMB 0925-0593 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 26.1 30-Month Interview (PB, EH, TT-HI, TT-LI, PBS) Form and Instruction New Repair queued
Form 25.1 Core Questionnaire (PB, EH, TT-HI, TT-LI, PBS) Form and Instruction New Repair queued
Form 20.1 Physical Measures - Child Blood Pressure (12-,24-Month) (PB, EH, TT-HI) Form and Instruction New Repair queued
Form 19.1 Physical Measures - Child Anthropometry (6-,12-,24-Month) (PB, EH, TT-HI) Form and Instruction New Available
Form 16.2 Biospecimen Sample Collection - Mother / Baby (PB, EH, TT-LI) Form and Instruction New Repair queued
Form 6.1 Tracing Interview (PB, EH, TT-HI, TT-LI, PBS) Form and Instruction New Available
Form 5.1 Participant Verification (PB, EH, TT-HI, TT-HI, PBS) Form and Instruction New Repair queued
Form 3.1 Nonrespondent Questionnaire (PB, EH, TT-HI, TT-LI, PBS) Form and Instruction New Repair queued
Form 2.3 Provider-Based Sampling Frame Questionnaire (PBS) Form and Instruction New Available
Form 1.1 Provider-Based Sampling Eligibility Screener (PBS) Form and Instruction New Repair queued
Form 24.4 24-Month Interview (PB, EH, TT-HI, TT-LI, PBS) Form and Instruction Modified Repair queued
Form 23.1 18-Month Interview (PB, EH, TT-HI, TT-LI, PBS) Form and Instruction Modified Repair queued
Form 22.1 12-Month Interview (PB, EH, TT-HI, PBS) Form and Instruction Modified Available
Form 21.1 9-Month Interview (PB, EH, TT-HI, TT-LI, PBS) Form and Instruction Modified Available
Form 18.1 6-Month Interview (PB, EH, TT-HI, PBS) Form and Instruction Modified Repair queued
Form 24.1 3-Month Interview (PB, EH, TT-HI, TT-LI, PBS) Form and Instruction Modified Available
Form 23.1 Low-Intensity Questionnaire (Child-focus) (TT-LI) Form and Instruction Removed Available
Form 15.1 Infant Feeding Log (PB, EH, TT-HI, PBS) Form and Instruction Modified Available
Form 14.1 Low-Intensity Questionnaire (Birth focus) (TT-LI) Form and Instruction Modified Available
Form 13.1 Birth Visit Interview (PB, EH, TT-HI, PBS) Form and Instruction Modified Available
Form 12.1 Father Interview (PB, EH, TT-HI) Form and Instruction Modified Available
Form 18.1 Father Informed Consent Form (PB, EH, TT-HI) Form and Instruction Removed Repair queued
Form 11.1 Pregnancy Health Care Log (PB, EH, TT-HI, PBS) Form and Instruction Modified Available
Form 9.1 Pregnancy Visit 2 Interview (PB, EH, TT-HI, PBS) Form and Instruction Modified Repair queued
Form 8.1 Pregnancy Visit 1 Interview (PB, EH, TT-HI, PBS) Form and Instruction Modified Available
Form 14.1 Pregnant Women's Informed Consent Form (PB, EH, TT-HI) Form and Instruction Removed Available
Form 4.1 Validation Interview - up to 30 months (PB, EH, TT-HI, TT-LI, PBS) Form and Instruction Modified Repair queued
Form 7.1 Low-Intensity Questionnaire (Found Pregnant) (TT-LI) Form and Instruction Modified Available
Form 11.1 Pregnancy Probability Group Follow Up Script (PB, EH, TT-HI, TT-LI) Form and Instruction Removed Available
Form 10.3 Biological and Environmental Sample Collection (Prenatal) (PB, EH, TT-HI, PBS) Form and Instruction Modified Available
Form 9.1 Pre-Pregnancy Interview (PB, EH, TT-HI) Form and Instruction Removed Repair queued
Form 8.1 Non-pregnant Women's Informed Consent (PB, EH, TT-HI) Form and Instruction Removed Repair queued
Form 7.1 Low-Intensity Consent Script (TT-LI) Form and Instruction Removed Repair queued
Form 6.1 Pregnancy Screener (TT-LI, TT-HI) Form and Instruction Removed Available
Form 5.1 Low-Intensity Invitation to High-Intensity Script (TT-HI) Form and Instruction Removed Repair queued
Form 4.1 Household Enumeration Instrument (EH) Form and Instruction Removed Available
Form 3.1 Healthcare Provider Questionnaire (PB) Form and Instruction Removed Repair queued
Form 2.1 Pregnancy Screener (PB, EH, TT-HI) Form and Instruction Removed Repair queued
PBS-SDM 2012-05 Provider Substitution Guidelines.docx Supplementary Document Uploaded 2012-08-17 Available
PBS-FSM 2012-04 Patient Recruitment Methods and Scenarios.docx Supplementary Document Uploaded 2012-08-17 Repair queued
NCS-FS_PBS Provider Substitution Form_2012-07-06.pdf Supplementary Document Uploaded 2012-08-17 Available
Checklist for Negotiating Logistics with Providers for the NCS.docx Supplementary Document Uploaded 2012-08-17 Available
Appendix 1 - Methods for Sampling Women within Selected Providers.xlsx Supplementary Document Uploaded 2012-08-17 Available
Provider-Based Sampling Arm Supporting Statement B FINAL 20120817.docx Supporting Statement B Uploaded 2012-08-17 Available
List of Instruments 20120416.docx Supplementary Document Uploaded 2012-04-17 Available
Consent Documents.pdf Supplementary Document Uploaded 2012-04-17 Repair queued
Itemized Burden Table.docx Supplementary Document Uploaded 2012-04-16 Available
NCS Certificate of Confidentiality.pdf Supplementary Document Uploaded 2012-04-16 Available
12 MO Child Saliva Instructions 20120413.docx Supplementary Document Uploaded 2012-04-16 Available
6, 12 MO Child Urine Collection Instructions 20120413.docx Supplementary Document Uploaded 2012-04-16 Repair queued
1, 3 MO Breast Milk Collection Instructions 20120413.docx Supplementary Document Uploaded 2012-04-16 Repair queued
12 MO Child Saliva Instructions 20120413.docx Supplementary Document Uploaded 2012-04-16 Repair queued
6, 12 MO Child Urine Collection Instructions 20120413.docx Supplementary Document Uploaded 2012-04-16 Available
1, 3 MO Breast Milk Collection Instructions 20120413.docx Supplementary Document Uploaded 2012-04-16 Available
Provider Based Sampling Provider List Revision Letter.doc Supplementary Document Uploaded 2012-04-16 Available
Provider Based Sampling Brochure.docx Supplementary Document Uploaded 2012-04-16 Available
Provider Based Sampling Advance Letter to Office Manager.docx Supplementary Document Uploaded 2012-04-16 Available
Exemplar Letter to Accompany Questionnaire.doc Supplementary Document Uploaded 2012-04-16 Repair queued
Advance Letter to Providers.docx Supplementary Document Uploaded 2012-04-16 Repair queued
Note to File - 24 Month -- Administration of Ages and Stages 3 Questionnaire.docx Supplementary Document Uploaded 2012-04-16 Available
Note to File - 18 Month -- Administration of Ages and Stages 3 Questionnaire.docx Supplementary Document Uploaded 2012-04-16 Available
Birth Visit VIS No Sample Collection 20120413.docx Supplementary Document Uploaded 2012-04-13 Available
Birth VIS With Samples 20120413.docx Supplementary Document Uploaded 2012-04-13 Repair queued
Note to File - Birth Visit - Umbilical Cord Blood Collection.docx Supplementary Document Uploaded 2011-04-08 Available
Father Visit Information Sheet 20120413.docx Supplementary Document Uploaded 2012-04-13 Repair queued
Pregnancy Visit 2 Visit Information Sheet.docx Supplementary Document Uploaded 2012-04-13 Repair queued
Pregnancy Visit 1 Visit Information Sheet.docx Supplementary Document Uploaded 2012-04-13 Available
Vacuum Bag Participant Instructions 20110211.doc Supplementary Document Uploaded 2012-04-17 Repair queued
Urine Collection Instructions 20110211.doc Supplementary Document Uploaded 2012-04-17 Available
Pre-Visit Instructions for Blood and Urine Collection 20110211.doc Supplementary Document Uploaded 2012-04-16 Available
Pre-Visit Information for Non Fasting Venous Blood Adult Urine Vacuum Collection 20110211.doc Supplementary Document Uploaded 2012-04-16 Repair queued
Pre-visit Information for Fasting Blood Urine Vacuum Collection 20110211.doc Supplementary Document Uploaded 2012-04-16 Repair queued
Note to File - Biological and Environmental Sample Collection (Prenatal).docx Supplementary Document Uploaded 2012-04-13 Repair queued
VBD Sample Distribution Script 20120413.docx Supplementary Document Uploaded 2012-04-13 Available
TWQ Sample Distribution Script 20120413.docx Supplementary Document Uploaded 2012-04-13 Available
TWF Sample Distribution Script 20120413.docx Supplementary Document Uploaded 2012-04-13 Repair queued
Provider-Based Sampling Arm Supporting Statement A FINAL 20120817.docx Supporting Statement A Uploaded 2012-08-17 Available
IC Document Collections
IC IDCollectionTypeStatusForm
202215 30-Month Interview (PB, EH, TT-HI, TT-LI, PBS) Form and Instruction New
202214 Core Questionnaire (PB, EH, TT-HI, TT-LI, PBS) Form and Instruction New
202213 Physical Measures - Child Blood Pressure (12-,24-Month) (PB, EH, TT-HI) Form and Instruction New
202212 Physical Measures - Child Anthropometry (6-,12-,24-Month) (PB, EH, TT-HI) Form and Instruction New
202211 Biospecimen Sample Collection - Mother / Baby (PB, EH, TT-LI) Form and Instruction New
202210 Tracing Interview (PB, EH, TT-HI, TT-LI, PBS) Form and Instruction New
202209 Participant Verification (PB, EH, TT-HI, TT-HI, PBS) Form and Instruction New
202208 Nonrespondent Questionnaire (PB, EH, TT-HI, TT-LI, PBS) Form and Instruction New
202207 Provider-Based Sampling Frame Questionnaire (PBS) Form and Instruction New
202206 Provider-Based Sampling Eligibility Screener (PBS) Form and Instruction New
193580 Formative - Developmental Instruction Modified
193579 24-Month Interview (PB, EH, TT-HI, TT-LI, PBS) Form and Instruction Modified
193578 18-Month Interview (PB, EH, TT-HI, TT-LI, PBS) Form and Instruction Modified
193577 12-Month Interview (PB, EH, TT-HI, PBS) Form and Instruction Modified
193576 9-Month Interview (PB, EH, TT-HI, TT-LI, PBS) Form and Instruction Modified
193575 6-Month Interview (PB, EH, TT-HI, PBS) Form and Instruction Modified
193574 3-Month Interview (PB, EH, TT-HI, TT-LI, PBS) Form and Instruction Modified
193573 Low-Intensity Questionnaire (Child-focus) (TT-LI) Form and Instruction Removed
193572 Infant Feeding Log (PB, EH, TT-HI, PBS) Form and Instruction Modified
193571 Low-Intensity Questionnaire (Birth focus) (TT-LI) Form and Instruction Modified
193570 Birth Visit Interview (PB, EH, TT-HI, PBS) Form and Instruction Modified
193569 Father Interview (PB, EH, TT-HI) Form and Instruction Modified
193568 Father Informed Consent Form (PB, EH, TT-HI) Form and Instruction Removed
193567 Pregnancy Health Care Log (PB, EH, TT-HI, PBS) Form and Instruction Modified
193566 Pregnancy Visit 2 Interview (PB, EH, TT-HI, PBS) Form and Instruction Modified
193565 Pregnancy Visit 1 Interview (PB, EH, TT-HI, PBS) Form and Instruction Modified
193564 Pregnant Women's Informed Consent Form (PB, EH, TT-HI) Form and Instruction Removed
193563 Validation Interview - up to 30 months (PB, EH, TT-HI, TT-LI, PBS) Form and Instruction Modified
193562 Low-Intensity Questionnaire (Found Pregnant) (TT-LI) Form and Instruction Modified
193561 Pregnancy Probability Group Follow Up Script (PB, EH, TT-HI, TT-LI) Form and Instruction Removed
193560 Biological and Environmental Sample Collection (Prenatal) (PB, EH, TT-HI, PBS) Form and Instruction Modified
193559 Pre-Pregnancy Interview (PB, EH, TT-HI) Form and Instruction Removed
193558 Non-pregnant Women's Informed Consent (PB, EH, TT-HI) Form and Instruction Removed
193557 Low-Intensity Consent Script (TT-LI) Form and Instruction Removed
193556 Pregnancy Screener (TT-LI, TT-HI) Form and Instruction Removed
193555 Low-Intensity Invitation to High-Intensity Script (TT-HI) Form and Instruction Removed
193554 Household Enumeration Instrument (EH) Form and Instruction Removed
193553 Healthcare Provider Questionnaire (PB) Form and Instruction Removed
184272 Pregnancy Screener (PB, EH, TT-HI) Form and Instruction Removed
184271 Address Lookup Tool (PB) Instruction Removed
ICR Details
0925-0593 201205-0925-002
Historical Active 201112-0925-004
HHS/NIH
Provider-Based Sampling Feasibility Study for the Vanguard (Pilot) Study and Data Collection Updates for the National Children's Study (NICHD)
Revision of a currently approved collection   No
Regular
Approved with change 08/31/2012
Retrieve Notice of Action (NOA) 05/09/2012
Approved consistent with the follow two terms: 1) In advance of adding biological and environmental sampling for the participants in the provider-based sampling arm of the Vanguard study, NIH will consult with the IRB amount whether the time between written consent for biosampling and the actual implementation of this activity warrents written re-consent. 2) NIH agrees to brief OMB/OIRA on the results of this test, particularly the measures in Table A.16 in advance of finalizing the design for the main study of the NCS.
  Inventory as of this Action Requested Previously Approved
08/31/2014 36 Months From Approved 07/31/2013
55,748 0 455,206
22,791 0 159,966
0 0 0

The National Children's Study is an integrated system of activities that includes a Vanguard (Pilot) Study for operations and methods development, and an NCS Main Study to collect data on exposure and response. The Vanguard (Pilot) Study, which includes the Initial Vanguard Study, the Alternate Recruitment Substudy (Phases 1 and 2), and the Provider-Based Sampling Feasibility Study (proposed in this information collection request), is currently underway. The Main Study is expected to follow within the next year. This request for revision includes (1) the addition of a Provider-Based Sampling Feasibility Study, and (2) supplemental measures for the Alternate Recruitment Substudy involving revised study visit assessments, physical measurements, and additional biospecimen collections. These information collections, revisions of instruments, physical measure implementation, and biospecimen collections will evaluate the feasibility, acceptability, and cost of study design elements to inform the Main Study.

PL: Pub.L. 106 - 310 1004 Name of Law: Childrens Health Act of 2000
  
None

Not associated with rulemaking

  77 FR 4569 01/30/2012
77 FR 24964 04/26/2012
Yes

27
IC Title Form No. Form Name
Pregnancy Visit 1 Interview (PB, EH, TT-HI, PBS) 8.1, 8.2 Survey ,   Survey
Pregnancy Visit 2 Interview (PB, EH, TT-HI, PBS) 9.1, 9.2 Survey ,   Survey
Pregnancy Health Care Log (PB, EH, TT-HI, PBS) 11.1 Log
Biological and Environmental Sample Collection (Prenatal) (PB, EH, TT-HI, PBS) 10.3, 10.4, 10.1, 10.2 Survey ,   Survey ,   Survey ,   Survey
Low-Intensity Questionnaire (Found Pregnant) (TT-LI) 7.1 Survey
Validation Interview - up to 30 months (PB, EH, TT-HI, TT-LI, PBS) 4.1 Survey
Father Interview (PB, EH, TT-HI) 12.1 Survey
Birth Visit Interview (PB, EH, TT-HI, PBS) 13.1 Survey
Low-Intensity Questionnaire (Birth focus) (TT-LI) 14.1 Survey
Infant Feeding Log (PB, EH, TT-HI, PBS) 15.1 Log
3-Month Interview (PB, EH, TT-HI, TT-LI, PBS) 24.1 Survey
6-Month Interview (PB, EH, TT-HI, PBS) 18.1, 18.2 Survey ,   Survey
9-Month Interview (PB, EH, TT-HI, TT-LI, PBS) 21.1 Survey
12-Month Interview (PB, EH, TT-HI, PBS) 22.1, 22.2, 22.3 Survey ,   Survey ,   Survey - Placeholder for Copyrighted Material
18-Month Interview (PB, EH, TT-HI, TT-LI, PBS) 23.1, 23.4, 23.2, 23.3, 23.5, 23.6 Survey ,   Survey - Placeholder for copyrighted material ,   Survey - Placeholder for copyrighted material ,   Survey - Placeholder for copyrighted material ,   Survey - Placeholder for copyrighted material ,   Survey - Placeholder for copyrighted material
Pregnancy Screener (TT-LI, TT-HI) 6.1 Survey
Low-Intensity Consent Script (TT-LI) 7.1 Consent
Physical Measures - Child Anthropometry (6-,12-,24-Month) (PB, EH, TT-HI) 19.1 Survey
Physical Measures - Child Blood Pressure (12-,24-Month) (PB, EH, TT-HI) 20.1 Survey
Core Questionnaire (PB, EH, TT-HI, TT-LI, PBS) 25.1 Survey
30-Month Interview (PB, EH, TT-HI, TT-LI, PBS) 26.2, 26.1, 26.3, 26.4 Survey ,   Survey - Placeholder for copyrighted material ,   Survey - Placeholder for copyrighted material ,   Survey
Pregnancy Screener (PB, EH, TT-HI) 2.1, 2.2, 2.3 Survey ,   Survey ,   Survey
Healthcare Provider Questionnaire (PB) 3.1 Survey
Household Enumeration Instrument (EH) 4.1 Survey
Low-Intensity Invitation to High-Intensity Script (TT-HI) 5.1 Survey
Address Lookup Tool (PB)
Non-pregnant Women's Informed Consent (PB, EH, TT-HI) 8.1 Consent
Pre-Pregnancy Interview (PB, EH, TT-HI) 9.1, 9.2 Survey ,   Survey
Pregnancy Probability Group Follow Up Script (PB, EH, TT-HI, TT-LI) 11.1, 11.2 Survey ,   Survey
Pregnant Women's Informed Consent Form (PB, EH, TT-HI) 14.1 Consent
Father Informed Consent Form (PB, EH, TT-HI) 18.1 Consent
Low-Intensity Questionnaire (Child-focus) (TT-LI) 23.1 Survey
24-Month Interview (PB, EH, TT-HI, TT-LI, PBS) 24.1, 24.2, 24.3, 24.4, 24.5 Survey - Placeholder for copyrighted material ,   Survey - Placeholder for copyrighted material ,   Survey ,   Survey ,   Survey - Placeholder for copyrighted material
Formative - Developmental
Provider-Based Sampling Eligibility Screener (PBS) 1.1 Survey
Provider-Based Sampling Frame Questionnaire (PBS) 2.3, 2.1, 2.2, 2.4 Survey ,   Survey ,   Survey ,   Survey
Tracing Interview (PB, EH, TT-HI, TT-LI, PBS) 6.1 Survey
Nonrespondent Questionnaire (PB, EH, TT-HI, TT-LI, PBS) 3.1 Survey
Participant Verification (PB, EH, TT-HI, TT-HI, PBS) 5.1 Survey
Biospecimen Sample Collection - Mother / Baby (PB, EH, TT-LI) 16.2, 16.1, 16.5, 16.3, 16.4 Survey ,   Survey ,   Survey ,   Survey ,   Survey

  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 55,748 455,206 0 -19,905 -379,553 0
Annual Time Burden (Hours) 22,791 159,966 0 -19,032 -118,143 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
This section describes program changes that are the result of deliberate Federal government action. As noted in Supporting Statement A.1 and A.2, the NCS halted ARS recruitment (Provider-Based Recruitment, Enhanced Household-Based Recruitment, Two-Tier Recruitment) in February 2012, eliminating the need for further screening and preconception data collection, which comprised the bulk of respondent burden in the Vanguard (Pilot) Study. This resulted in significantly decreased burden to the public. Currently, the NCS is approved for 159,966 annualized burden hours. In this information collection request, the total annualized hour burden for the ARS is 22,031. This request for revision proposes the addition of a Provider-Based Sampling Feasibility Study component of the Vanguard (Pilot) Study, supplemental measures involving Study Visit assessments, supplemental measures involving physical measurements, and supplemental collections involving biospecimens. These information collections, revisions of instruments, physical measure implementation, and biospecimen collections will evaluate the feasibility, acceptability, and cost of study design elements to inform the Main Study. The NCS intends to use a modular approach for Study Visit assessments. The Core Questionnaire (described in A.2) is intended to be administered at multiple study visits, and will be piloted at the 30-month visit. A modular approach will also be instituted for the informed consent process (described in B.2.1.) and the Tracing Interview (described in A.2). In the long term, we anticipate that the modular approach mentioned above will result in reduced administrative burden as well as the potential for reduced participant burden. To date, child physical measures have not yet been collected into the Vanguard (Pilot) Study. This collection will impose a relatively small amount of burden on the public. In addition, the re-introduction of child biospecimen collection into the Vanguard (Pilot) Study will also represent a relatively small amount of burden on the public. To accommodate Department of Health and Human Services data standards for the Affordable Care Act Measures, the NCS has proposed a plan to incorporate questions on ethnicity, race, sex, primary language / language spoken, and disability status into existing Study Visit assessments that are asked of mothers, fathers, children, and primary caregivers, and range from before the child is born until 5 years of age. Upon finalization of this plan, this will result in a minimal public burden increase.

$71,904,774
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Mikia Currie 3014350941

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
05/09/2012