3-Month Interview

Continuation of National Children's Study Vanguard (Pilot) Study Data Collection: Study Visits through 60-Months and Sibling Birth Enrollment

OMB: 0925-0593

IC ID: 193574

Information Collection (IC) Details

View Information Collection (IC)

3-Month Interview
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 11.1 Survey 3M_2MonthASQ3.docx Yes Yes Paper Only
Form and Instruction 11.3 Survey 3M_EdinburghPostNatalDepressScalesSAQ.docx Yes Yes Paper Only
Form and Instruction 11.4 Survey 3M_InfantBehaviorRevised3SubscalesSAQ.docx Yes Yes Paper Only
Form and Instruction 11.5 Survey 3MonthQuestionnaireChild.docx Yes Yes Paper Only
Form and Instruction 11.6 Survey 3MonthQuestionnaireBIOMom.docx Yes Yes Paper Only
Form and Instruction 11.7 Survey 3MonthQuestionnaireAdult.docx Yes Yes Paper Only
Form and Instruction 11.8 Survey 3MonthQuestionnaireHousehold.docx Yes Yes Paper Only
Form and Instruction 11.2 Survey 3M_4MonthASQ3.docx Yes Yes Paper Only

General Science and Innovation Scientific and Technological Research and Innovation

 

475 0
   
Individuals or Households
 
   0 %

  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 475 0 -1,043 0 0 1,518
Annual IC Time Burden (Hours) 372 0 -134 0 0 506
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
HIPAAHealthUseDisclosureAuthorizationForm HIPAAHealthUseDisclosureAuthorizationForm.docx 01/14/2014
InformedConsentFormAdult InformedConsentFormAdult.docx 01/14/2014
MultiModeVisitInformationScript MultiModeVisitInformationScript.docx 01/14/2014
ASQ3PhoneInstructions ASQ3PhoneInstructions.docx 01/15/2014
3M_EdinburghPostnatalDepressionScaleInstructions 3M_EdinburghPostnatalDepressionScaleInstructions.docx 01/15/2014
3M_InfantBehaviorRevised3SubscalesInstructions 3M_InfantBehaviorRevised3SubscalesInstructions.docx 01/15/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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