Information Collection

Formative - Developmental

IC 193580 under ICR 201211-0925-001 · OMB 0925-0593.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0593 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Burden 19 HiLo Household Inventory Questionnaire 20110420 - LOIx-QUEX-01-B-1.DOCX	Instruction
Burden 20 Participant Internet Usage and Contact Preference Survey 20110420 - LOI2-INF-17.docx	Instruction
Burden 125 Exemplar Demographics 20110621 - LOI3-PHYS-02.docx	Instruction
Burden 250 Measurement Form 20110621 - LOI3-PHYS-02.pdf	Instruction
Burden 38 Contact Info 20110621 - LOI3-PHYS-01.docx	Instruction
Burden 38 Exit Survey 20110621 - LOI3-PHYS-01.docx	Instruction
Burden 38 Visit Screen 20110621 - LOI3-PHYS-01.docx	Instruction
Burden 75 Questionnaire 20110621 - LOI3-PHYS-01.docx	Instruction
Burden 15 Acculturation Instrument 20110621 - LOI2-QUEX-14.docx	Instruction
Burden 37 Second Acceptability Questionnaire 20110621 - LOI2-QUEX-14.doc	Instruction
Burden 38 Initial Acceptability Questionnaire 20110621 - LOI2-QUEX-14.doc	Instruction
Burden 90 Food Record 20110621 - LOI2-QUEX-14.docx	Instruction
Burden 100 NCS FFQ 20110621 - LOI2-QUEX-14.pdf	Instruction
Burden 38 Screening 20110621 - LOI3-PHYS-01.docx	Instruction
Burden 250 NCS ASA24 Protocol (Placeholder for web survey) 20110621 - LOI2-QUEX-14.docx	Instruction
Burden 900 B.1.2 LOI3-BIO-02 Exemplar Screening Interview.docx	Instruction
Burden 900 B.1.7 LOI3-BIO-02 Exemplar Interview.docx	Instruction
Burden 225 B.2.4 LOI2-PHYS-15 Exemplar Participant Experience Survey.docx	Instruction
Attach B5. LOI2-QUEX-14 ASA24 Protocol.docx	Instruction
Attach B6. LOI2-QUEX-14 Food Diary Instructions-Parent.doc	Instruction
Attach B4. LOI2-QUEX-14 ASA24 Instructions.pdf	Instruction
Note to File - Formative Research (updated 20130204).docx	Other-Research
17.1 Survey Attach B3. LOI2-QUEX-14 SocioDemographics.docx	Form and Instruction
17.2 Survey Attach B7. LOI2-QUEX-14 Infant Acceptability Questionnaire #1.doc	Form and Instruction
17.3 Survey Attach B8. LOI2-QUEX-14 Infant Acceptability Questionnaire #2.doc	Form and Instruction
17.4 Survey Attach B9. LOI2-QUEX-14 Child Acceptability Questionnaire #1.doc	Form and Instruction
17.5 Survey Attach B10. LOI2-QUEX-14 Child Acceptability Questionnaire #2.doc	Form and Instruction
17.6 Survey Attach B11. LOI2-QUEX-14 Infant Feeding Questionniare.pdf	Form and Instruction
17.8 Survey Attach B16. LOI2-QUEX-14 Recruitment Screener.pdf	Form and Instruction
17.9 Survey Attach B21. Biospecimen Infant Blood Spot Instrument.docx	Form and Instruction
17.10 Survey Attach B22. Biospecimen Cord Blood Instrument.docx	Form and Instruction
17.11 Survey Attach B23. Biospecimen Placenta and Umbilical Cord Data Collection.docx	Form and Instruction
17.7 Survey Attach B12. LOI2-QUEX-14 Child Food Questionnaire.pdf	Form and Instruction
Attach B25. Participant Verification Birth Cohort Attach B25. Participant Verification Birth Cohort.docx	Form and Instruction
Attach B2. LOI2-QUEX-14 Exemplar Consent Form.doc Attach B2. LOI2-QUEX-14 Exemplar Consent Form	IC Document
Attach B13. LOI2-QUEX-14 IRB Approval Letters.pdf Attach B13. LOI2-QUEX-14 IRB Approval Letters	IC Document
Attach B15. LOI2-QUEX-14 Exemplar Recruitment Flyer.docx Attach B15. LOI2-QUEX-14 Exemplar Recruitment Flyer	IC Document
Attach B17. Vanguard Pilot Study Biospecimen Collection Chart.docx Attach B17. Vanguard (Pilot) Study Biospecimen Collection Chart	IC Document
Attach B14. LOI2-QUEX-14 Manual of Procedures.pdf Attach B14. LOI2-QUEX-14 Manual of Procedures	IC Document
Attach B1. LOI2-QUEX-14-Phase 2 OIRA Template.docx Attach B1. LOI2-QUEX-14-Phase 2 OIRA Template	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Formative - Developmental

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Other-Research			Note to File - Formative Research (updated 20130204).docx	Yes	Yes	Paper Only
Form and Instruction	none	Attach B25. Participant Verification Birth Cohort	Attach B25. Participant Verification Birth Cohort.docx	Yes	Yes	Paper Only
Instruction			Burden 19 HiLo Household Inventory Questionnaire 20110420 - LOIx-QUEX-01-B-1.DOCX	Yes	Yes	Paper Only
Instruction			Burden 20 Participant Internet Usage and Contact Preference Survey 20110420 - LOI2-INF-17.docx	Yes	Yes	Paper Only
Instruction			Burden 125 Exemplar Demographics 20110621 - LOI3-PHYS-02.docx	Yes	Yes	Paper Only
Instruction			Burden 250 Measurement Form 20110621 - LOI3-PHYS-02.pdf	Yes	Yes	Paper Only
Instruction			Burden 38 Contact Info 20110621 - LOI3-PHYS-01.docx	Yes	Yes	Paper Only
Instruction			Burden 38 Exit Survey 20110621 - LOI3-PHYS-01.docx	Yes	Yes	Paper Only
Instruction			Burden 38 Visit Screen 20110621 - LOI3-PHYS-01.docx	Yes	Yes	Paper Only
Instruction			Burden 75 Questionnaire 20110621 - LOI3-PHYS-01.docx	Yes	Yes	Paper Only
Instruction			Burden 15 Acculturation Instrument 20110621 - LOI2-QUEX-14.docx	Yes	Yes	Paper Only
Instruction			Burden 37 Second Acceptability Questionnaire 20110621 - LOI2-QUEX-14.doc	Yes	Yes	Paper Only
Instruction			Burden 38 Initial Acceptability Questionnaire 20110621 - LOI2-QUEX-14.doc	Yes	Yes	Paper Only
Instruction			Burden 90 Food Record 20110621 - LOI2-QUEX-14.docx	Yes	Yes	Paper Only
Instruction			Burden 100 NCS FFQ 20110621 - LOI2-QUEX-14.pdf	Yes	Yes	Paper Only
Instruction			Burden 38 Screening 20110621 - LOI3-PHYS-01.docx	Yes	Yes	Paper Only
Instruction			Burden 250 NCS ASA24 Protocol (Placeholder for web survey) 20110621 - LOI2-QUEX-14.docx	Yes	Yes	Paper Only
Instruction			Burden 900 B.1.2 LOI3-BIO-02 Exemplar Screening Interview.docx	Yes	Yes	Paper Only
Instruction			Burden 900 B.1.7 LOI3-BIO-02 Exemplar Interview.docx	Yes	Yes	Paper Only
Instruction			Burden 225 B.2.4 LOI2-PHYS-15 Exemplar Participant Experience Survey.docx	Yes	Yes	Paper Only
Form and Instruction	17.1	Survey	Attach B3. LOI2-QUEX-14 SocioDemographics.docx	Yes	Yes	Paper Only
Instruction			Attach B5. LOI2-QUEX-14 ASA24 Protocol.docx	Yes	Yes	Paper Only
Instruction			Attach B6. LOI2-QUEX-14 Food Diary Instructions-Parent.doc	Yes	Yes	Paper Only
Form and Instruction	17.2	Survey	Attach B7. LOI2-QUEX-14 Infant Acceptability Questionnaire #1.doc	Yes	Yes	Fillable Printable
Form and Instruction	17.3	Survey	Attach B8. LOI2-QUEX-14 Infant Acceptability Questionnaire #2.doc	Yes	Yes	Fillable Printable
Form and Instruction	17.4	Survey	Attach B9. LOI2-QUEX-14 Child Acceptability Questionnaire #1.doc	Yes	Yes	Fillable Printable
Form and Instruction	17.5	Survey	Attach B10. LOI2-QUEX-14 Child Acceptability Questionnaire #2.doc	Yes	Yes	Fillable Printable
Form and Instruction	17.6	Survey	Attach B11. LOI2-QUEX-14 Infant Feeding Questionniare.pdf	Yes	Yes	Paper Only
Form and Instruction	17.8	Survey	Attach B16. LOI2-QUEX-14 Recruitment Screener.pdf	Yes	Yes	Paper Only
Form and Instruction	17.9	Survey	Attach B21. Biospecimen Infant Blood Spot Instrument.docx	Yes	Yes	Paper Only
Form and Instruction	17.10	Survey	Attach B22. Biospecimen Cord Blood Instrument.docx	Yes	Yes	Paper Only
Form and Instruction	17.11	Survey	Attach B23. Biospecimen Placenta and Umbilical Cord Data Collection.docx	Yes	Yes	Paper Only
Form and Instruction	17.7	Survey	Attach B12. LOI2-QUEX-14 Child Food Questionnaire.pdf	Yes	Yes	Fillable Printable
Instruction			Attach B4. LOI2-QUEX-14 ASA24 Instructions.pdf	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: 4,847

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	Previously Approved
Annual Number of Responses for this IC	4,847	4,847
Annual IC Time Burden (Hours)	4,847	4,847
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attach B2. LOI2-QUEX-14 Exemplar Consent Form	Attach B2. LOI2-QUEX-14 Exemplar Consent Form.doc	10/19/2012
Attach B13. LOI2-QUEX-14 IRB Approval Letters	Attach B13. LOI2-QUEX-14 IRB Approval Letters.pdf	10/19/2012
Attach B15. LOI2-QUEX-14 Exemplar Recruitment Flyer	Attach B15. LOI2-QUEX-14 Exemplar Recruitment Flyer.docx	10/19/2012
Attach B17. Vanguard (Pilot) Study Biospecimen Collection Chart	Attach B17. Vanguard Pilot Study Biospecimen Collection Chart.docx	10/19/2012
Attach B14. LOI2-QUEX-14 Manual of Procedures	Attach B14. LOI2-QUEX-14 Manual of Procedures.pdf	10/19/2012
Attach B1. LOI2-QUEX-14-Phase 2 OIRA Template	Attach B1. LOI2-QUEX-14-Phase 2 OIRA Template.docx	11/01/2012

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