Itemized Burden Table

OMB # 0925-0593

Expiration Date: 7/31/2013

Phase 2e

Itemized Burden Table

Estimated Annualized Hour Burden and Cost for Vanguard (Pilot) Study Respondents, Prenatal to 30 Months of Age of the Child

Data Collection Activity	Type of Respondent	Estimated Number of Respondents	Estimated Number of Responses per Respondent	Average Burden Per Response (in hours)	Estimated Total Annual Burden Hours	Estimated Total Annual Respondent Cost
Screening Activities
Provider Based Sampling Eligibility Screener (PBS)	Pregnant Women	3,125	1	20/60	1,042	$10,417
Provider Based Sampling Frame Questionnaire (PBS)	Healthcare Providers	50	1	25/60	21	$2,104
Continuous Activities
Nonrespondent Questionnaire (PB, EH, TT-HI, TT-LI, PBS)	Pregnant Women, Mothers or Fathers	480	1	5/60	40	$400
Validation Interview - up to 30 Months (PB, EH, TT-HI, TT-LI, PBS)	Respondents	1,268	1	5/60	106	$1,057
Participant Verification (PB, EH, TT-HI, TT-LI, PBS)	Pregnant Women, Mothers or Fathers	2,320	1	5/60	193	$1,933
Tracing Interview (PB, EH, TT-HI, TT-LI, PBS)	Respondents	1,167	13	10/60	2,528	$25,281
Pregnancy Activities
Low-intensity Questionnaire (Found Pregnant) (TT-LI)	Pregnant Women	173	1	15/60	43	$432
Pregnancy Visit 1 Interview (PB, EH, TT-HI, PBS)	Pregnant Women	2,018	1	35/60	1,177	$11,774
Pregnancy Visit 2 Interview (PB, EH, TT-HI, PBS)	Pregnant Women	1,817	1	25/60	757	$7,569
Biological and Environmental Sample Collection - Prenatal (PB, EH, TT-HI)	Pregnant Women	1,456	2	60/60	2,913	$29,127
Pregnancy Health Care Log (PB, EH, TT-HI, PBS)	Pregnant Women	1,615	1	20/60	538	$5,382
Father Interview (PB, EH, TT-HI)	Alternate Caregiver	818	1	35/60	477	$4,770
Birth-Related Activities
Birth Visit Interview (PB, EH, TT-HI, PBS)	Mother / Baby	1,141	1	20/60	380	$3,802
Low-intensity Questionnaire (Birth-focus) (TT-LI)	Mother / Baby	432	1	15/60	108	$1,080
Postnatal Activities
Infant Feeding Log (PB, EH, TT-HI, PBS)	Mother / Baby	1,106	1	20/60	369	$3,688
Biological Sample Collection - Mother/Baby (PB, EH, TT-HI)	Mother / Baby	761	4	22.5/60	1,141	$11,411
3-Month Interview (PB, EH, TT-HI, TT-LI, PBS)	Mother /Baby	1,518	1	20/60	506	$5,061
6-Month Interview (PB, EH, TT-HI, PBS)	Mother / Baby	1,066	1	30/60	533	$5,331
Physical Measures - Child Anthropometry (6-,12-,24-Month) (PB, EH, TT-HI)	Baby / Child	701	3	20/60	701	$7,014
Physical Measures - Child Blood Pressure (12-,24-Month) (PB, EH, TT-HI)	Baby / Child	675	2	10/60	225	$2,250
9-Month Interview (PB, EH, TT-HI, TT-LI, PBS)	Mother / Baby	1,428	1	10/60	238	$2,381
12-Month Interview (PB, EH, TT-HI, PBS)	Mother / Baby	1,003	1	50/60	836	$8,360
18-Month Interview (PB, EH, TT-HI, TT-LI, PBS)	Mother / Child	1,316	1	30/60	658	$6,582
24-Month Interview (PB, EH, TT-HI, TT-LI, PBS)	Mother / Child	1,251	1	35/60	729	$7,295
Core Questionnaire (PB, EH, TT-HI, TT-LI, PBS)	Mother / Child	1,188	1	30/60	594	$5,940
30-Month Visit Interview (PB, EH, TT-HI, TT-LI, PBS)	Mother / Child	1,188	1	55/60	1,089	$10,890
Total, Vanguard (Pilot) Study		31,082			17,943	$181,331
Total, Formative Research					4,847	$48,473
Grand Total		31,082			22,791	$229,804