54-Month Interview

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

OMB: 0925-0593

IC ID: 210028

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

54-Month Interview
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 36.1 Survey 54MQuestionnaireChild.docx Yes Yes Paper Only
Form and Instruction 36.3 Survey DietaryFoodFrequencySAQ.docx Yes Yes Paper Only
Form and Instruction 1 54M Questionnaire Adult Attach 4. 54M Questionnaire Adult.docx Yes Yes Paper Only

General Science and Innovation Scientific and Technological Research and Innovation

 

1,431 0
   
Individuals or Households
 
   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 1,431 0 0 0 0 1,431
Annual IC Time Burden (Hours) 804 0 0 0 0 804
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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.
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