Stress and Cortisol Measurement for the National Childrens Study (NICHD)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 3.1 Survey	Form and Instruction	Modified	Available
Form 2.1 Attach 8. Take Home Packet	Form and Instruction	Modified	Available
Form 1.3 Attach 6. Demographic and Health Survey	Form	Modified	Available
Form 1.5 Survey	Form and Instruction	Modified	Available
Form 1.4 Survey	Form and Instruction	Modified	Available
Form 1.2 Form	Form	Modified	Available
Form 1.1 Survey	Form and Instruction	Modified	Available
Stress and Cortisol Supporting Statement B FINAL 20121205.docx	Supporting Statement B	Uploaded 2012-12-06	Available
Itemized Burden Table.docx	Supplementary Document	Uploaded 2012-12-06	Available
Attach 11. Postpartum Abstraction Form.doc	Supplementary Document	Uploaded 2012-12-06	Available
Attach 5. Enrollment Medical Record Abstraction Form.doc	Supplementary Document	Uploaded 2012-12-06	Available
Attach 12. Protocol Summary Excerpt.pdf	Supplementary Document	Uploaded 2012-12-06	Available
Attach 13. IRB Approval Letters.pdf	Supplementary Document	Uploaded 2012-12-06	Available
Attach 3. Exemplar Consent Form.docx	Supplementary Document	Uploaded 2012-12-06	Available
Attach 1. Exemplar Recruitment Flyer.doc	Supplementary Document	Uploaded 2012-12-06	Available
Attach 18. Visit 2 Blood Processing Protocol.docx	Supplementary Document	Uploaded 2012-12-06	Available
Attach 16. Study Visit 2 Blood Requisition Form.docx	Supplementary Document	Uploaded 2012-12-06	Available
Attach 14. Study Hair Collection Protocol.docx	Supplementary Document	Uploaded 2012-12-06	Available
Attach 17. Visit 1 Blood Processing Protocol.doc	Supplementary Document	Uploaded 2012-12-06	Available
Attach 15. Study Visit 1 Blood Requisition Form.docx	Supplementary Document	Uploaded 2012-12-06	Available
Stress and Cortisol Supporting Statement A FINAL 20130307.docx	Supporting Statement A	Uploaded 2013-03-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
205264	Follow Up Studies	Other-Note to File	New
203352	Clinic Visit 2	Form and Instruction	Modified	Survey
203351	Ambulatory Assessment Period	Form and Instruction	Modified	Attach 8. Take Home Packet
203351	Ambulatory Assessment Period	Instruction	Modified
203350	Clinic Visit 1	Form	Modified	Attach 6. Demographic and Health Survey
203350	Clinic Visit 1	Form and Instruction	Modified	Survey
203350	Clinic Visit 1	Form and Instruction	Modified	Survey
203350	Clinic Visit 1	Form	Modified	Form
203350	Clinic Visit 1	Form and Instruction	Modified	Survey

ICR Details

OMB Control No: 0925-0671	ICR Reference No: 201301-0925-001
Status: Historical Active	Previous ICR Reference No: 201207-0925-002
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Stress and Cortisol Measurement for the National Childrens Study (NICHD)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/25/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/04/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2016	36 Months From Approved
Responses	1,399	0	0
Time Burden (Hours)	3,147	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: With this submission, the NCS seeks OIRA clearance to perform a multi-center substudy, called the Stress and Cortisol Measurement Substudy, aimed at developing a validated questionnaire that will reflect specific physiological measures of stress. This substudy will develop a common, core protocol for determining the most reliable, acceptable, and cost-efficient approach for assessing maternal stress in the form of a brief questionnaire that correlates with more invasive and burdensome approaches to the measurement of biological and physiological measures of stress. Birth outcomes have been selected for this substudy because they represent priority outcomes for the NCS, and they will be available and can be collected within the study timeframe. Identification of a standardized, validated approach to evaluate exposure to psychosocial stress during pregnancy will facilitate the measurement of stress as a variable of interest in the NCS by providing an efficient, low-burden approach to stress measurement.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 9666	02/17/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 30294	05/22/2012
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Ambulatory Assessment Period	2.1	Attach 8. Take Home Packet
Clinic Visit 1	1.1, 1.2, 1.4, 1.5, 1.3	Survey ,   Form ,   Survey ,   Survey ,   Attach 6. Demographic and Health Survey
Clinic Visit 2	3.1	Survey
Follow Up Studies

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,399	0	0	1,399	0	0
Annual Time Burden (Hours)	3,147	0	0	3,147	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This request proposes a new data collection.

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Annual Cost to Federal Government: $605,887

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/04/2013

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