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18-Month Interview
Continuation of National Children's Study Vanguard (Pilot) Study Data Collection: Study Visits through 60-Months
OMB: 0925-0593
IC ID: 193578
OMB.report
HHS/NIH
OMB 0925-0593
ICR 201407-0925-005
IC 193578
( )
Documents and Forms
Document Name
Document Type
Form 15.1
18-Month Interview
Form and Instruction
15.1 Survey
EmotionBattery_NIHToolbox.docx
Form and Instruction
15.2 Survey
MCHATSAQ.docx
Form and Instruction
15.4 Survey
18MQuestionnaireChild.docx
Form and Instruction
15.5 Survey
18MQuestionnaireAdult.docx
Form and Instruction
15.6 Survey
18M_PAIRQuestionnaireCASI.docx
Form and Instruction
MCHATInPersonMailInstructions.docx
MCHATInPersonMailInstructions
IC Document
PAIRSAQInstructions.docx
PAIRSAQInstructions
IC Document
HIPAAHealthUseDisclosureAuthorizationForm.docx
HIPAAHealthUseDisclosureAuthorizationForm
IC Document
Attach 10. Informed Consent Form - Adult.docx
InformedConsentFormAdult
IC Document
Attach 12. Parental Permission Child Participation - Birth to 6Months.docx
ParentalPermissionChildParticipation6MonthtoAgeMajority
IC Document
Attach 13. Multi-Mode Visit Information Script.docx
MultiModeVisitInformationScript
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
18-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
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
15.1
Survey
EmotionBattery_NIHToolbox.docx
Yes
Yes
Paper Only
Form and Instruction
15.2
Survey
MCHATSAQ.docx
Yes
Yes
Paper Only
Form and Instruction
15.4
Survey
18MQuestionnaireChild.docx
Yes
Yes
Paper Only
Form and Instruction
15.5
Survey
18MQuestionnaireAdult.docx
Yes
Yes
Paper Only
Form and Instruction
15.6
Survey
18M_PAIRQuestionnaireCASI.docx
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
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:
562
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
562
0
0
0
0
562
Annual IC Time Burden (Hours)
475
0
0
0
0
475
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
MCHATInPersonMailInstructions
MCHATInPersonMailInstructions.docx
11/07/2013
PAIRSAQInstructions
PAIRSAQInstructions.docx
11/08/2013
HIPAAHealthUseDisclosureAuthorizationForm
HIPAAHealthUseDisclosureAuthorizationForm.docx
01/15/2014
InformedConsentFormAdult
Attach 10. Informed Consent Form - Adult.docx
07/24/2014
ParentalPermissionChildParticipation6MonthtoAgeMajority
Attach 12. Parental Permission Child Participation - Birth to 6Months.docx
07/24/2014
MultiModeVisitInformationScript
Attach 13. Multi-Mode Visit Information Script.docx
07/24/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.