LOI2-QUEX-5 Bayley-3 Short Form for the National Children's Study AND LOI3-MHLTH-09 A Methodological Study to Assess Mental Disorders for NCS Birth Parents

Neuropsychosocial Measures Formative Research Methodology Studies for the National Childrens Study (NICHD)

OMB: 0925-0661

IC ID: 208126

⚠️ Notice: This information collection may be referencing outdated material.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

2014-12-03 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Document Name Document Type
Form 1.1 LOI2-QUEX-5 Bayley-3 Short Form for the National Children's Study AND LOI3-MHLTH-09 A Methodological Study to Assess Mental Disorders for NCS Birth Parents Form and Instruction
1.1 Survey A.1 LOI2-QUEX-5 Exemplar Telephone Screener.docx Form and Instruction
1.3 Survey B.3 LOI3-MHLTH-09 Recruitment Script.docx Form and Instruction
1.5 Survey B.5 LOI3-MHLTH-09 Revised CIDI.docx Form and Instruction
1.2 Survey - Placeholder for Copyrighted Item A.7 LOI2-QUEX-5 Bayley Instrument Cover Sheet.docx Form and Instruction
1.4 Survey B.4 LOI3-MHLTH-09 Parental Mental Health Screen.docx Form and Instruction
A.2 LOI2-QUEX-5 Exemplar Consent Form.docx A.2 LOI2-QUEX-5 Exemplar Consent Form IC Document
A.3 LOI2-QUEX-5 Exemplar Recuitment Cover Letter.docx A.3 LOI2-QUEX-5 Exemplar Recuitment Cover Letter IC Document
A.4 LOI2-QUEX-5 Exemplar Flyer.docx A.4 LOI2-QUEX-5 Exemplar Flyer IC Document
A.5 LOI2-QUEX-5 Bayley 3 Approved Project Protocol.docx A.5 LOI2-QUEX-5 Bayley 3 Approved Project Protocol IC Document
A.6 LOI2-QUEX-5 IRB Approval Letters.pdf A.6 LOI2-QUEX-5 IRB Approval Letters IC Document
B.1 LOI3-MHLTH-09 IRB Protocol.docx B.1 LOI3-MHLTH-09 IRB Protocol IC Document
B.2 LOI3-MHLTH-09 IRB Approval Letter.pdf B.2 LOI3-MHLTH-09 IRB Approval Letter IC Document
B.7 LOI3-MHLTH-09 Flyers.pdf B.7 LOI3-MHLTH-09 Flyers IC Document
B.8 LOI3-MHLTH-09 Brochures.pdf B.8 LOI3-MHLTH-09 Brochures IC Document
B.6 LOI3-MHLTH-09 Consent Form.pdf B.6 LOI3-MHLTH-09 Consent Form IC Document
A. LOI2-QUEX-5 Bayley-3 OIRA Template 11182013 Revised.docx LO12-QUEX-5 Baley3 Template IC Document
B. LOI3-MHLTH-09 OIRA Template 11182013 Revised.docx LO13-MHLTH-09 TEmplate IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	LOI2-QUEX-5 Bayley-3 Short Form for the National Children's Study AND LOI3-MHLTH-09 A Methodological Study to Assess Mental Disorders for NCS Birth Parents	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1.1	Survey	A.1 LOI2-QUEX-5 Exemplar Telephone Screener.docx	Yes	Yes	Paper Only
Form and Instruction	1.3	Survey	B.3 LOI3-MHLTH-09 Recruitment Script.docx	Yes	Yes	Paper Only
Form and Instruction	1.5	Survey	B.5 LOI3-MHLTH-09 Revised CIDI.docx	Yes	Yes	Paper Only
Form and Instruction	1.2	Survey - Placeholder for Copyrighted Item	A.7 LOI2-QUEX-5 Bayley Instrument Cover Sheet.docx	Yes	Yes	Paper Only
Form and Instruction	1.4	Survey	B.4 LOI3-MHLTH-09 Parental Mental Health Screen.docx	Yes	Yes	Paper Only

Federal Enterprise Architecture Business Reference Module

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: 3,450	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	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	5,050	0	0	0	0	0
Annual IC Time Burden (Hours)	1,589	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
A.2 LOI2-QUEX-5 Exemplar Consent Form	A.2 LOI2-QUEX-5 Exemplar Consent Form.docx	06/19/2013
A.3 LOI2-QUEX-5 Exemplar Recuitment Cover Letter	A.3 LOI2-QUEX-5 Exemplar Recuitment Cover Letter.docx	06/19/2013
A.4 LOI2-QUEX-5 Exemplar Flyer	A.4 LOI2-QUEX-5 Exemplar Flyer.docx	06/19/2013
A.5 LOI2-QUEX-5 Bayley 3 Approved Project Protocol	A.5 LOI2-QUEX-5 Bayley 3 Approved Project Protocol.docx	06/19/2013
A.6 LOI2-QUEX-5 IRB Approval Letters	A.6 LOI2-QUEX-5 IRB Approval Letters.pdf	06/19/2013
B.1 LOI3-MHLTH-09 IRB Protocol	B.1 LOI3-MHLTH-09 IRB Protocol.docx	06/19/2013
B.2 LOI3-MHLTH-09 IRB Approval Letter	B.2 LOI3-MHLTH-09 IRB Approval Letter.pdf	06/19/2013
B.7 LOI3-MHLTH-09 Flyers	B.7 LOI3-MHLTH-09 Flyers.pdf	06/19/2013
B.8 LOI3-MHLTH-09 Brochures	B.8 LOI3-MHLTH-09 Brochures.pdf	06/19/2013
B.6 LOI3-MHLTH-09 Consent Form	B.6 LOI3-MHLTH-09 Consent Form.pdf	07/12/2013
LO12-QUEX-5 Baley3 Template	A. LOI2-QUEX-5 Bayley-3 OIRA Template 11182013 Revised.docx	11/22/2013
LO13-MHLTH-09 TEmplate	B. LOI3-MHLTH-09 OIRA Template 11182013 Revised.docx	11/22/2013

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