Form 45.1 Survey

OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

Father Post-Natal Questionnaire - Child, Phase 2g

OMB Specification

Father Post-Natal Questionnaire - Child

Event Category:	Trigger-Based
Event:	Post-natal Father
Administration:	9M, 18M
Instrument Target:	Father/Father Figure
Instrument Respondent:	Father/Father Figure
Domain:	Questionnaire
Document Category:	Questionnaire
Method:	Data Collector Administered
Mode (for this instrument*):	In-Person, CAI; Phone, CAI
OMB Approved Modes:	In-Person, CAI; Phone CAI; Web-Based CAI
Estimated Administration Time:	2 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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Father Post-Natal Questionnaire - Child

TABLE OF CONTENTS

GENERAL PROGRAMMER INSTRUCTIONS: 1

PATERNAL INVOLVEMENT 3

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Father Post-Natal Questionnaire - Child

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.

PATERNAL INVOLVEMENT

(TIME_STAMP_PI_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

• PRELOAD PARTICIPANT ID (P_ID) FOR CHILD AND RESPONDENT ID (R_P_ID) FOR PRIMARY CAREGIVER-IDENTIFIED FATHER.

• PRELOAD FIRST NAME OF CHILD (C_FNAME) FROM  PARTICIPANT VERIFICATION, SCHEDULING, & TRACING QUESTIONNAIRE (INSTRUMENT_ID = XX) AND DISPLAY APPROPRIATE NAME IN “C_FNAME” THROUGHOUT THE INSTRUMENT.

• OTHERWISE, IF C_FNAME = -1 OR -2, DISPLAY “the child” IN APPROPRIATE FIELDS THROUGHOUT THE INSTRUMENT.

PI01000. Now I'd like to ask about {C_FNAME/the child}.   

PI02000/(F_CHILD_1HR). In the past month, how often have you spent one or more hours a day with {C_FNAME/the child}?  Have you spent one or more hours a day;  every day or almost every day, a few times a week, a few times a month, once or twice, or never? 

Label	Code	Go To
EVERY DAY OR ALMOST EVERY DAY	1
A FEW TIMES A WEEK	2
A FEW TIMES A MONTH	3
ONCE OR TWICE	4
NEVER	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) Nine-month Non-resident Father Questionnaire (Question 3) 

PI03000. Next I’d like to ask you about different things you may do with {C_FNAME/the child}.  In a typical week, how often do you do the following things with {C_FNAME/the child}? ?Would you say not at all, once or twice, 3 to 6 times, or every day?

SOURCE

New

PI04000/(F_READ). Read books to {C_FNAME/the child}?  

INTERVIEWER INSTRUCTIONS

• RE-READ STATEMENT (Would you say not at all, once or twice, 3 to 6 times, or every day?) AS NEEDED.

Label	Code	Go To
NOT AT ALL	1
ONCE OR TWICE	2
3 TO 6 TIMES	3
EVERY DAY	4
REFUSED	-1
DON’T KNOW	-2

SOURCE

Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) Nine-month Resident Father Questionnaire (Question 2) 

PI05000/(F_STORIES). Tell stories to {C_FNAME/the child}?  

INTERVIEWER INSTRUCTIONS

• RE-READ STATEMENT (Would you say not at all, once or twice, 3 to 6 times, or every day?) AS NEEDED.

Label	Code	Go To
NOT AT ALL	1
ONCE OR TWICE	2
3 TO 6 TIMES	3
EVERY DAY	4
REFUSED	-1
DON’T KNOW	-2

SOURCE

Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) Nine-month Resident Father Questionnaire (Question 2) 

PI06000/(F_SONGS). Sing songs with {C_FNAME/the child}?  

INTERVIEWER INSTRUCTIONS

• RE-READ STATEMENT (Would you say not at all, once or twice, 3 to 6 times, or every day?) AS NEEDED.

Label	Code	Go To
NOT AT ALL	1
ONCE OR TWICE	2
3 TO 6 TIMES	3
EVERY DAY	4
REFUSED	-1
DON’T KNOW	-2

SOURCE

Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) Nine-month Resident Father Questionnaire (Question 2) 

PI07000/(F_ERRANDS). Take {C_FNAME/the child} along while doing errands like going to the post office, the bank, or the store?  

INTERVIEWER INSTRUCTIONS

• RE-READ STATEMENT (Would you say not at all, once or twice, 3 to 6 times, or every day?) AS NEEDED.

Label	Code	Go To
NOT AT ALL	1
ONCE OR TWICE	2
3 TO 6 TIMES	3
EVERY DAY	4
REFUSED	-1
DON’T KNOW	-2

SOURCE

Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) Nine-month Resident Father Questionnaire (Question 2) 

PI08000. My next question is about your goals for {C_FNAME/the child}’s future.

SOURCE

New introductory text prepared and tested in pilot study telephone interviews to develop NCS Father Follow-Up Telephone Interview (modified) 

PI09000/(SCHOOL_GOAL). How far in school do you want {C_FNAME/the child} to go?  Would you say you want {C_FNAME/the child}...

Label	Code	Go To
To receive less than a high school diploma	1
To graduate from high school	2
To go to vocational, trade, or business school after high school	3
To attend two or more years of college	4
To finish a four- or five-year college degree	5
To earn a Master's degree or equivalent	6
To finish a Ph.D., M.D., or other advanced degree	7
REFUSED	-1
DON’T KNOW	-2

SOURCE

Early Childhood Longitudinal Study-Kindergarten (ECLS-K) 1998-99, Fall Parent Interview Question PIQ 120 (modified)

(TIME_STAMP_PI_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

Public reporting burden for this collection of information is estimated to average 2 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.