Attach B25. Participant Verification Birth Cohort

OMB #: 0925-0593

OMB Expiration Date: 08/31/2014

PBS Participant Verification Birth Cohort Interview, Phase 2e

PBS Participant Verification Birth Cohort Interview

Event:	Birth
Participant:	Perinatal Woman
Respondent:	Perinatal Woman
Domain:	Questionnaire
Type of Document:	Interview
Allowable Mode:	In-person (CAPI), Telephone (CATI)
Allowable Method:	Interviewer-Administered
Recruitment Groups:	PBS
Version:	1.0
Release:	MDES 3.2

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PBS Participant Verification Birth Cohort Interview

TABLE OF CONTENTS

GENERAL PROGRAMMER INSTRUCTIONS 1

PBS PARTICIPANT VERIFICATION BIRTH COHORT INTERVIEW 2

PBS Participant Verification Birth Cohort Interview

GENERAL PROGRAMMER INSTRUCTIONS

WHEN PROGRAMMING INSTRUMENTS, VALIDATE FIELD LENGTHS AND TYPES AGAINST THE MDES TO ENSURE DATA COLLECTION RESPONSES DO NOT EXCEED THOSE OF THE MDES. SOME GENERAL ITEM LIMITS USED ARE AS FOLLOWS:

DATA ELEMENT FIELDS	MAXIMUM CHARACTERS PERMITTED	PROGRAMMER INSTRUCTIONS
ADDRESS AND EMAIL FIELDS	100
UNIT AND PHONE FIELDS	10
_OTH AND COMMENT FIELDS	255
FIRST NAME, MIDDLE NAME, AND LAST NAME	30
ALL ID FIELDS	36
ZIP CODE	5
ZIP CODE LAST FOUR	4
CITY	50
DOB AND ALL OTHER DATE FIELDS (E.G., DT, DATE, ETC.)	10	DISPLAY AS MM/DD/YYYY STORE AS YYYY-MM-DD HARD EDITS: MM MUST EQUAL 00 TO 12 DD MUST EQUAL 01 TO 31 YYYY MUST BE BETWEEN 1900 AND CURRENT YEAR.
TIME VARIABLES	TWO-DIGIT HOUR AND TWO-DIGIT MINUTE, AM/PM DESIGNATION	HARD EDITS: HOURS MUST BE BETWEEN 00 AND 12; MINUTES MUST BE BETWEEN 00 AND 59

Instrument Guidelines for Participant IDs:

THE P_ID IN THE MDES HEADER IS THAT OF THE PARTICIPANT (E.G. THE PERINATAL WOMAN).

PBS PARTICIPANT VERIFICATION BIRTH COHORT INTERVIEW

(TIME_STAMP_PBC_ST). PROGRAMMER INSTRUCTION:

• INSERT DATE/TIME STAMP.

• PRELOAD P_ID AND P_TYPE.

• THIS INTERVIEW ONLY ADMINISTERED IF P_TYPE = 15.

PBC010/(MULT_CHILD). IS THERE MORE THAN ONE CHILD ELIGIBLE FOR THE BIRTH INTERVIEW TODAY?

INTERVIEWER INSTRUCTION:

• DO NOT ADMINISTER THIS ITEM TO THE PARENT/CAREGIVER.

YES 1

NO 2 (C_FNAME)(C_LNAME)

PROGRAMMER INSTRUCTION:

• IF MULT_CHILD = 2, SET CHILD_QNUM = 1.

PBC020/(CHILD_NUM). HOW MANY CHILDREN ARE ELIGIBLE FOR THE BIRTH INTERVIEW TODAY?

INTERVIEWER INSTRUCTION:

• DO NOT ADMINISTER THIS ITEM TO THE PARENT/CAREGIVER.

|___|___|

NUMBER OF CHILDREN

PBC030/(CHILD_QNUM). WHICH NUMBER CHILD IS THIS QUESTIONNAIRE LOOP FOR?

INTERVIEWER INSTRUCTION:

• DO NOT ADMINISTER THIS ITEM TO THE PARENT/CAREGIVER.

• ENTER “1” AT BEGINNING OF INTERVIEW FOR FIRST CHILD.

|___|___|

NUMBER

PROGRAMMER INSTRUCTIONS:

• CHILD_QNUM CANNOT BE GREATER THAN CHILD_NUM.

PBC040/(C_FNAME)(C_LNAME). What is the child’s full name?

INTERVIEWER INSTRUCTIONS:

• IF PARENT/CAREGIVER REFUSES TO PROVIDE INFORMATION, RE-STATE CONFIDENTIALITY PROTECTIONS, ASK FOR INITIALS OR SOME OTHER NAME TO CALL THE CHILD.

• CONFIRM SPELLING OF FIRST NAME IF NOT PREVIOUSLY COLLECTED AND OF LAST NAME.

_____________________ _____________________

FIRST NAME LAST NAME

REFUSED -1

DON’T KNOW -2

PBC050/(CHILD_SEX). What is the child’s sex?

MALE 1

FEMALE 2

REFUSED -1

DON’T KNOW -2

PBC060/(RESP_GUARD). Are you {C_FNAME/the child}’s legal guardian?

INTERVIEWER INSTRUCTIONS:

• IF THE BIOLOGICAL MOTHER IS THE LEGAL GUARDAIN CONTINUE VISIT.

• IF THE BIOLOGICAL MOTHER IS NOT THE LEGAL GUARDIAN OR SHE ANSWERS REFUSED OR DON’T KNOW, THEN THANK HER FOR HER TIME AND END THE VISIT.

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF MULT_CHILD = 2, GO TO TIME_STAMP_PBC_ET.

• IF MULT_CHILD = 1 AND

  • IF CHILD_QNUM ≠ CHILD_NUM, GO TO CHILD_QNUM AND INCREMENT BY ONE.

  • IF CHILD_QNUM = CHILD_NUM, GO TO TIME_STAMP_PBC_ET.

(TIME_STAMP_PBC_ET). PROGRAMMER INSTRUCTION:

• INSERT DATE/TIME STAMP.

Public reporting burden for this collection of information is estimated to average 2 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0593*). Do not return the completed form to this address.