25.6 Survey

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

BreastMilkKitDistributionInstrument

Adult-Focused Biospecimen Collection (Postnatal)

OMB: 0925-0593

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OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

Breast Milk Kit Distribution Instrument, Phase 2g

OMB Specification


Breast Milk Kit Distribution Instrument


Event Category:

Time-Based

Event:

Birth, 3M

Administration:

N/A

Instrument Target:

Biological Mother

Instrument Respondent:

Data Collector

Domain:

Biospecimen

Document Category:

Sample Collection

Method:

Data Collector Administered

Mode (for this instrument*):

In-Person, CAI

OMB Approved Modes:

In-Person, CAI

Estimated Administration Time:

3 minutes

Multiple Child/Sibling Consideration:

Per Event

Special Considerations:

N/A

Version:

1.0

MDES Release:

4.0


*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.


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Breast Milk Kit Distribution Instrument



TABLE OF CONTENTS





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Breast Milk Kit Distribution Instrument



GENERAL PROGRAMMER INSTRUCTIONS:

WHEN PROGRAMMING INSTRUMENTS, VALIDATE FIELD LENGTHS AND TYPES AGAINST THE MDES TO ENSURE DATA COLLECTION RESPONSES DO NOT EXCEED THOSE OF THE MDES. SOME GENERAL ITEM LIMITS USED ARE AS FOLLOWS:


DATA ELEMENT FIELDS

MAXIMUM CHARACTERS PERMITTED

DATA TYPE

PROGRAMMER INSTRUCTIONS

ADDRESS AND EMAIL FIELDS

100

CHARACTER


UNIT AND PHONE FIELDS

10

CHARACTER


_OTH AND COMMENT FIELDS

255

CHARACTER

  • Limit text to 255 characters

FIRST NAME AND LAST NAME

30

CHARACTER

  • Limit text to 30 characters

ALL ID FIELDS

36

CHARACTER


ZIP CODE

5

NUMERIC


ZIP CODE LAST FOUR

4

NUMERIC


CITY

50

CHARACTER


DOB AND ALL OTHER DATE FIELDS (E.G., DT, DATE, ETC.)

10

NUMERIC


CHARACTER



  • DISPLAY AS MM/DD/YYYY

  • STORE AS YYYY-MM-DD

  • HARD EDITS:

MM MUST EQUAL 01 TO 12

DD MUST EQUAL 01 TO 31

YYYY MUST BE BETWEEN 1900 AND CURRENT YEAR.

TIME VARIABLES

TWO-DIGIT HOUR AND TWO-DIGIT MINUTE, AM/PM DESIGNATION

NUMERIC

  • HARD EDITS:

HOURS MUST BE BETWEEN 00 AND 12;

MINUTES MUST BE BETWEEN 00 AND 59


Instrument Guidelines for Participant and Respondent IDs:

PRENATALLY, THE P_ID IN THE MDES HEADER IS THAT OF THE PARTICIPANT (E.G. THE NON-PREGNANT WOMAN, PREGNANT WOMAN, OR THE FATHER).


POSTNATALLY, A RESPONDENT ID WILL BE USED IN ADDITION TO THE PARTICIPANT ID BECAUSE SOMEBODY OTHER THAN THE PARTICIPANT MAY BE COMPLETING THE INTERVIEW. FOR EXAMPLE, THE PARTICIPANT MAY BE THE CHILD AND THE RESPONDENT MAY BE THE MOTHER, FATHER, OR ANOTHER CAREGIVER. THEREFORE, MDES VERSION 2.2 AND ALL FUTURE VERSIONS CONTAIN A R_P_ID (RESPONDENT PARTICIPANT ID) HEADER FIELD FOR EACH POST-BIRTH INSTRUMENT. THIS WILL ALLOW ROCs TO INDICATE WHETHER THE RESPONDENT IS SOMEBODY OTHER THAN THE PARTICIPANT ABOUT WHOM THE QUESTIONS ARE BEING ASKED.



A REMINDER:

ALL RESPONDENTS MUST BE CONSENTED AND HAVE RECORDS IN THE PERSON, PARTICIPANT, PARTICIPANT_CONSENT AND LINK_PERSON_PARTICIPANT TABLES, WHICH CAN BE PRELOADED INTO EACH INSTRUMENT. ADDITIONALLY, IN POST-BIRTH QUESTIONNAIRES WHERE THERE IS THE ABILITY TO LOOP THROUGH A SET OF QUESTIONS FOR MULTIPLE CHILDREN, IT IS IMPORTANT TO CAPTURE AND STORE THE CORRECT CHILD P_ID ALONG WITH THE LOOP INFORMATION. IN THE MDES VARIABLE LABEL/DEFINITION COLUMN, THIS IS INDICATED AS FOLLOWS: EXTERNAL IDENTIFIER: PARTICIPANT ID FOR CHILD DETAIL.





BREAST MILK KIT DISTRIBUTION


(TIME_STAMP_BMK_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

  • PRELOAD PARTICIPANT ID (P_ID) FOR BIOLOGICAL MOTHER.

  • PRELOAD STAFF_ID AND ​EVENT_TYPE.


BMK01000/(KIT_DISTRIBUTED). WAS A KIT DISTRIBUTED?


Label

Code

Go To

YES

1


NO

2

KIT_DISTRIB_REAS


BMK02000/(KIT_DISTRIB_METHOD). HOW WAS THE KIT DISTRIBUTED?


Label

Code

Go To

HAND-DELIVERY AT BIRTH EVENT

1

BMK05000

MAILING

2

BMK05000


BMK03000/(KIT_DISTRIB_REAS). REASON KIT NOT DISTRIBUTED:


Label

Code

Go To

MOTHER REFUSED

1

KIT_COMMENTS

KIT UNAVAILABLE

2

KIT_COMMENTS

NO TIME TO DISTRIBUTE KIT

3

KIT_COMMENTS

OTHER

-5



BMK04000/(KIT_DISTRIB_REAS_OTH). SPECIFY: ___________________________________


PROGRAMMER INSTRUCTIONS

  • GO TO BMK10000.


BMK05000. DATE OF KIT DISTRIBUTION:


(KIT_DISTRIB_MM) |___|___|

  M     M


(KIT_DISTRIB_DD) |___|___|

   D     D


(KIT_DISTRIB_YYYY) |2|0|___|___|

 Y Y   Y      Y


BMK06000/(SPECIMEN_ID). |__|__|__|__|__|__|__|__|__|-|__|__|__|__|


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF FORMAT IS NOT TWO ALPHA, SEVEN NUMERIC CHARACTERS DASH TWO ALPHA, TWO NUMERIC CHARACTERS (AA#######-AA##)


BMK07000. ANTICIPATED SPECIMEN COLLECTION DATE:


(KIT_COLLECTION_MM) |___|___|

   M    M 


(KIT_COLLECTION_DD) |___|___|

   D    D


(KIT_COLLECTION_YYYY) |2|0|___|___|

 Y Y   Y     Y


BMK08000/(KIT_COMMENTS). DO YOU HAVE ANY COMMENTS ABOUT THE KIT DISTRIBUTION?


Label

Code

Go To

YES

1


NO

2

BMK10000


BMK09000/(KIT_COMMENTS_OTH). COMMENTS: ___________________________________________________________________


BMK10000. DATE OF INSTRUMENT COMPLETION:


(DATE_COMPLETE_MM) |___|___|

  M     M


(DATE_COMPLETE_DD) |___|___|

   D    D


(DATE_COMPLETE_YYYY) |2|0|___|___|

 Y Y   Y     Y


(TIME_STAMP_BMK_ET).


PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP


Public reporting burden for this collection of information is estimated to average 3 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.

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