35.3 Survey

OMB #: 0925-0593

OMB Expiration Date: 08/31/2014

NIH Toolbox Parent Proxy Emotion Battery, Phase 2g

NIH Toolbox Parent Proxy Emotion Battery

Event Category:	Time-Based
Event:	48M
Administration:	N/A
Instrument Target:	Child
Instrument Respondent:	Primary Caregiver
Domain:	Neuro-Psychosocial
Document Category:	Scored Assessment
Mode (for this instrument*):	In-Person, CAI
OMB Approved Modes:	Web-Based, CAI; In-Person, CAI
Method:	Data Collector Administered
Estimated Administration Time:	15 minutes
Multiple Child/Sibling Consideration:	Per Child
Special Considerations:	N/A
Version:	1.0
MDES Release:	4.0
Publisher:	NIH Toolbox
NCS Contact:	Carol Andreassen Westat 301-251-1500

*This instrument is OMB-approved for multi-mode administration but this version of the instrument is designed for administration in this/these mode(s) only.

Parent Proxy Emotion Battery

The NIH Toolbox is a research-based battery of cognitive, sensory, motor, and emotional function measures that was developed and nationally normed for ages 3-85 (www.nihtoolbox.org). The Parent Proxy Emotion Battery is a series of questionnaires the parent/caregiver completes about the child. This battery, recommended for parents/caregivers of children ages 3-12, includes measures of Positive Affect, General Life Satisfaction, Positive Peer Interaction, Social Withdrawal, Peer Rejection, Empathic Behaviors, Self-Efficacy, Perceived Stress, Fear, Sadness and Anger. The administration time is approximately 15 minutes.

Public reporting burden for this collection of information is estimated to average 15 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.