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Federal forms, ICRs, and supporting documents

Information Collection

LOI2 QUEX 8 Development and Validation of an Autism Case Confirmation Approach for Use in the National Children's Study

IC 204488 under ICR 201412-0925-001 · OMB 0925-0661.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 1.5
LOI2 QUEX 8 Development and Validation of an Autism Case Confirmation Approach for Use in the National Children's Study		 Form and Instruction
1.5 LOI2 QUEX-8 Parent Video-Guided Self Report (VGPR)
Attach 5 LOI2-QUEX-8 - Parent Video-Guided Self Report (VGPR).pdf 		Form and Instruction
1.6 LOI2 QUEX-8 Screening Tool for Autism in Toddlers (STAT-
Attach 6 LOI2-QUEX-8 - Screening Tool for Autism in Toddlers (STAT-NCS).docx 		Form and Instruction
1.2 LOI2 QUEX-8 Exemplar Telephone Script
Attach 2 LOI2-QUEX-8 Exemplar Telephone Script.pdf 		Form and Instruction
1.4 LO12 QUEX-8 Autism Diagnostic Screener (ADI-S)
Attach_4_LOI2-QUEX-8_-_Autism_Diagnostic_Interview-Screener_(ADI-S).docx 		Form and Instruction
Attach 1 LOI2-QUEX-8 IRB Approvals.pdf
LOI2-QUEX-8 IRB Approvals		IC Document
Attach 3 LOI2-QUEX-8 - ASD Scheduled Assessment Summary Sheet.docx
LOI2-QUEX-8 - ASD Scheduled Assessment Summary Sheet		IC Document
Attach 7 LOI2 QUEX-8 Exemplar Informed Consent Main Sample.doc
LOI2 QUEX-8 Exemplar Informed Consent Main Sample		IC Document
Attach 8 LOI2 QUEX-8 Exemplar Informed Consent Sup Sample.doc
LOI2 QUEX-8 Exemplar Informed Consent Sup Sample		IC Document
Attach 9 LOI2-QUEX-8 Exemplar Recruitment Flyer.pdf
LOI2-QUEX-8 Exemplar Recruitment Flyer		IC Document
Attach 10 LOI2-QUEX-8 IRB Protocol.pdf
LOI2-QUEX-8 IRB Protocol		IC Document
LOI2-QUEX-8 - OIRA Template.docx
LOI2-QUEX-8 - OIRA Template		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1.5 LOI2 QUEX-8 Parent Video-Guided Self Report (VGPR) Attach 5 LOI2-QUEX-8 - Parent Video-Guided Self Report (VGPR).pdf Yes Yes Paper Only
Form and Instruction 1.6 LOI2 QUEX-8 Screening Tool for Autism in Toddlers (STAT-NCS) Attach 6 LOI2-QUEX-8 - Screening Tool for Autism in Toddlers (STAT-NCS).docx Yes Yes Paper Only
Form and Instruction 1.2 LOI2 QUEX-8 Exemplar Telephone Script Attach 2 LOI2-QUEX-8 Exemplar Telephone Script.pdf Yes Yes Paper Only
Form and Instruction 1.4 LO12 QUEX-8 Autism Diagnostic Screener (ADI-S) Attach_4_LOI2-QUEX-8_-_Autism_Diagnostic_Interview-Screener_(ADI-S).docx Yes Yes Printable Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Requested 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 1,425 0 0 0 0 1,425
Annual IC Time Burden (Hours) 1,275 0 0 0 0 1,275
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
LOI2-QUEX-8 IRB Approvals Attach 1 LOI2-QUEX-8 IRB Approvals.pdf 08/28/2012
LOI2-QUEX-8 - ASD Scheduled Assessment Summary Sheet Attach 3 LOI2-QUEX-8 - ASD Scheduled Assessment Summary Sheet.docx 08/28/2012
LOI2 QUEX-8 Exemplar Informed Consent Main Sample Attach 7 LOI2 QUEX-8 Exemplar Informed Consent Main Sample.doc 08/28/2012
LOI2 QUEX-8 Exemplar Informed Consent Sup Sample Attach 8 LOI2 QUEX-8 Exemplar Informed Consent Sup Sample.doc 08/28/2012
LOI2-QUEX-8 Exemplar Recruitment Flyer Attach 9 LOI2-QUEX-8 Exemplar Recruitment Flyer.pdf 08/28/2012
LOI2-QUEX-8 IRB Protocol Attach 10 LOI2-QUEX-8 IRB Protocol.pdf 08/28/2012
LOI2-QUEX-8 - OIRA Template LOI2-QUEX-8 - OIRA Template.docx 08/28/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.