30-Month Interview

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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 27.1 30-Month Interview Form and Instruction
27.1 Survey BriefInfantToddlerSocialEmotionalAssessmentSAQ.docx Form and Instruction
27.2 Survey 30M_BriefSymptomInventorySAQ.docx Form and Instruction
27.3 Survey 30M_InfantToddlerSensoryProfileSAQ.docx Form and Instruction
27.4 Survey 30MQuestionnaireChild.docx Form and Instruction
27.5 Survey 30MQuestionnaireAdult.docx Form and Instruction
BITSEAInPersonMailInstructions.docx BITSEAInPersonMailInstructions IC Document
BITSEAPhoneInstructions.docx BITSEAPhoneInstructions IC Document
30M_BSIMailInstructions.docx 30M_BSIMailInstructions IC Document
30M_InfantToddlerSensoryProfileMailInstructions.docx 30M_InfantToddlerSensoryProfileMailInstructions IC Document
30M_InfantToddlerSensoryProfilePhoneInstructions.docx 30M_InfantToddlerSensoryProfilePhoneInstructions IC Document
HIPAAHealthUseDisclosureAuthorizationForm.docx HIPAAHealthUseDisclosureAuthorizationForm IC Document
InformedConsentFormAdult.docx InformedConsentFormAdult IC Document
MultiModeVisitInformationScript.docx MultiModeVisitInformationScript IC Document
ParentalPermissionChildParticipation6MonthtoAgeMajority.docx ParentalPermissionChildParticipation6MonthtoAgeMajority IC Document

Information Collection (IC) Details

IC Title:	30-Month Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	27.1	Survey	BriefInfantToddlerSocialEmotionalAssessmentSAQ.docx	Yes	Yes	Paper Only
Form and Instruction	27.2	Survey	30M_BriefSymptomInventorySAQ.docx	Yes	Yes	Paper Only
Form and Instruction	27.3	Survey	30M_InfantToddlerSensoryProfileSAQ.docx	Yes	Yes	Paper Only
Form and Instruction	27.4	Survey	30MQuestionnaireChild.docx	Yes	Yes	Paper Only
Form and Instruction	27.5	Survey	30MQuestionnaireAdult.docx	Yes	Yes	Paper Only

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: 1,286	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,286	98	1,188
Annual IC Time Burden (Hours)	1,302	213	1,089
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
BITSEAInPersonMailInstructions	BITSEAInPersonMailInstructions.docx	11/07/2013
BITSEAPhoneInstructions	BITSEAPhoneInstructions.docx	11/07/2013
30M_BSIMailInstructions	30M_BSIMailInstructions.docx	11/07/2013
30M_InfantToddlerSensoryProfileMailInstructions	30M_InfantToddlerSensoryProfileMailInstructions.docx	11/07/2013
30M_InfantToddlerSensoryProfilePhoneInstructions	30M_InfantToddlerSensoryProfilePhoneInstructions.docx	11/07/2013
HIPAAHealthUseDisclosureAuthorizationForm	HIPAAHealthUseDisclosureAuthorizationForm.docx	01/15/2014
InformedConsentFormAdult	InformedConsentFormAdult.docx	01/15/2014
MultiModeVisitInformationScript	MultiModeVisitInformationScript.docx	01/15/2014
ParentalPermissionChildParticipation6MonthtoAgeMajority	ParentalPermissionChildParticipation6MonthtoAgeMajority.docx	01/15/2014

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