Information Collection

18-Month Interview

IC 193578 under ICR 201407-0925-005 · OMB 0925-0593.

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	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

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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	562	562
Annual IC Time Burden (Hours)	475	475
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.