Information Collection

LOI2 QUEX 8 Development and Validation of an Autism Case Confirmation Approach for Use in the National Children's Study

IC 204488 under ICR 201206-0925-004 · OMB 0925-0661.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0661 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1.4 LOI2 QUEX 8 Development and Validation of an Autism Case Confirmation Approach for Use in the National Children's Study	Form and Instruction
1.5 LOI2 QUEX-8 Parent Video-Guided Self Report (VGPR) Attach 5 LOI2-QUEX-8 - Parent Video-Guided Self Report (VGPR).pdf	Form and Instruction
1.6 LOI2 QUEX-8 Screening Tool for Autism in Toddlers (STAT- Attach 6 LOI2-QUEX-8 - Screening Tool for Autism in Toddlers (STAT-NCS).docx	Form and Instruction
1.2 LOI2 QUEX-8 Exemplar Telephone Script Attach 2 LOI2-QUEX-8 Exemplar Telephone Script.pdf	Form and Instruction
1.4 LO12 QUEX-8 Autism Diagnostic Screener (ADI-S) Attach_4_LOI2-QUEX-8_-_Autism_Diagnostic_Interview-Screener_(ADI-S).docx	Form and Instruction
Attach 1 LOI2-QUEX-8 IRB Approvals.pdf LOI2-QUEX-8 IRB Approvals	IC Document
Attach 3 LOI2-QUEX-8 - ASD Scheduled Assessment Summary Sheet.docx LOI2-QUEX-8 - ASD Scheduled Assessment Summary Sheet	IC Document
Attach 7 LOI2 QUEX-8 Exemplar Informed Consent Main Sample.doc LOI2 QUEX-8 Exemplar Informed Consent Main Sample	IC Document
Attach 8 LOI2 QUEX-8 Exemplar Informed Consent Sup Sample.doc LOI2 QUEX-8 Exemplar Informed Consent Sup Sample	IC Document
Attach 9 LOI2-QUEX-8 Exemplar Recruitment Flyer.pdf LOI2-QUEX-8 Exemplar Recruitment Flyer	IC Document
Attach 10 LOI2-QUEX-8 IRB Protocol.pdf LOI2-QUEX-8 IRB Protocol	IC Document
LOI2-QUEX-8 - OIRA Template.docx LOI2-QUEX-8 - OIRA Template	IC Document

IC Title:

LOI2 QUEX 8 Development and Validation of an Autism Case Confirmation Approach for Use in the National Children's Study

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1.4	LO12 QUEX-8 Autism Diagnostic Screener (ADI-S)	Attach_4_LOI2-QUEX-8_-_Autism_Diagnostic_Interview-Screener_(ADI-S).docx	Yes	Yes	Printable Only
Form and Instruction	1.2	LOI2 QUEX-8 Exemplar Telephone Script	Attach 2 LOI2-QUEX-8 Exemplar Telephone Script.pdf	Yes	Yes	Paper Only
Form and Instruction	1.5	LOI2 QUEX-8 Parent Video-Guided Self Report (VGPR)	Attach 5 LOI2-QUEX-8 - Parent Video-Guided Self Report (VGPR).pdf	Yes	Yes	Paper Only
Form and Instruction	1.6	LOI2 QUEX-8 Screening Tool for Autism in Toddlers (STAT-NCS)	Attach 6 LOI2-QUEX-8 - Screening Tool for Autism in Toddlers (STAT-NCS).docx	Yes	Yes	Paper Only

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 980

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	1,425	0	0	0	0	0
Annual IC Time Burden (Hours)	1,275	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
LOI2-QUEX-8 IRB Approvals	Attach 1 LOI2-QUEX-8 IRB Approvals.pdf	08/28/2012
LOI2-QUEX-8 - ASD Scheduled Assessment Summary Sheet	Attach 3 LOI2-QUEX-8 - ASD Scheduled Assessment Summary Sheet.docx	08/28/2012
LOI2 QUEX-8 Exemplar Informed Consent Main Sample	Attach 7 LOI2 QUEX-8 Exemplar Informed Consent Main Sample.doc	08/28/2012
LOI2 QUEX-8 Exemplar Informed Consent Sup Sample	Attach 8 LOI2 QUEX-8 Exemplar Informed Consent Sup Sample.doc	08/28/2012
LOI2-QUEX-8 Exemplar Recruitment Flyer	Attach 9 LOI2-QUEX-8 Exemplar Recruitment Flyer.pdf	08/28/2012
LOI2-QUEX-8 IRB Protocol	Attach 10 LOI2-QUEX-8 IRB Protocol.pdf	08/28/2012
LOI2-QUEX-8 - OIRA Template	LOI2-QUEX-8 - OIRA Template.docx	08/28/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.