Information Collection

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

IC 208126 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⚠️ Notice: This information collection may be referencing outdated material.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:

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

Documents and Forms

Documents and forms in this information collection
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:

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	1.1	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 %

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	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

table that charts IC Documents
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.