Information Collection

LOI2-QUEX-5 Bayley-3 Short Form for the National Children's Study AND LOI3-MHLTH-09 A Methodological Study to Assess Mental Disorders for NCS Birth Parents

IC 208126 under ICR 201412-0925-001 · OMB 0925-0661.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1.1 LOI2-QUEX-5 Bayley-3 Short Form for the National Children's Study AND LOI3-MHLTH-09 A Methodological Study to Assess Mental Disorders for NCS Birth Parents	Form and Instruction
1.1 Survey A.1 LOI2-QUEX-5 Exemplar Telephone Screener.docx	Form and Instruction
1.3 Survey B.3 LOI3-MHLTH-09 Recruitment Script.docx	Form and Instruction
1.5 Survey B.5 LOI3-MHLTH-09 Revised CIDI.docx	Form and Instruction
1.2 Survey - Placeholder for Copyrighted Item A.7 LOI2-QUEX-5 Bayley Instrument Cover Sheet.docx	Form and Instruction
1.4 Survey B.4 LOI3-MHLTH-09 Parental Mental Health Screen.docx	Form and Instruction
A.2 LOI2-QUEX-5 Exemplar Consent Form.docx A.2 LOI2-QUEX-5 Exemplar Consent Form	IC Document
A.3 LOI2-QUEX-5 Exemplar Recuitment Cover Letter.docx A.3 LOI2-QUEX-5 Exemplar Recuitment Cover Letter	IC Document
A.4 LOI2-QUEX-5 Exemplar Flyer.docx A.4 LOI2-QUEX-5 Exemplar Flyer	IC Document
A.5 LOI2-QUEX-5 Bayley 3 Approved Project Protocol.docx A.5 LOI2-QUEX-5 Bayley 3 Approved Project Protocol	IC Document
A.6 LOI2-QUEX-5 IRB Approval Letters.pdf A.6 LOI2-QUEX-5 IRB Approval Letters	IC Document
B.1 LOI3-MHLTH-09 IRB Protocol.docx B.1 LOI3-MHLTH-09 IRB Protocol	IC Document
B.2 LOI3-MHLTH-09 IRB Approval Letter.pdf B.2 LOI3-MHLTH-09 IRB Approval Letter	IC Document
B.7 LOI3-MHLTH-09 Flyers.pdf B.7 LOI3-MHLTH-09 Flyers	IC Document
B.8 LOI3-MHLTH-09 Brochures.pdf B.8 LOI3-MHLTH-09 Brochures	IC Document
B.6 LOI3-MHLTH-09 Consent Form.pdf B.6 LOI3-MHLTH-09 Consent Form	IC Document
A. LOI2-QUEX-5 Bayley-3 OIRA Template 11182013 Revised.docx LO12-QUEX-5 Baley3 Template	IC Document
B. LOI3-MHLTH-09 OIRA Template 11182013 Revised.docx LO13-MHLTH-09 TEmplate	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

LOI2-QUEX-5 Bayley-3 Short Form for the National Children's Study AND LOI3-MHLTH-09 A Methodological Study to Assess Mental Disorders for NCS Birth Parents

Agency IC Tracking Number:

IC Status: Unchanged

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	1.1	Survey	A.1 LOI2-QUEX-5 Exemplar Telephone Screener.docx	Yes	Yes	Paper Only
Form and Instruction	1.3	Survey	B.3 LOI3-MHLTH-09 Recruitment Script.docx	Yes	Yes	Paper Only
Form and Instruction	1.5	Survey	B.5 LOI3-MHLTH-09 Revised CIDI.docx	Yes	Yes	Paper Only
Form and Instruction	1.2	Survey - Placeholder for Copyrighted Item	A.7 LOI2-QUEX-5 Bayley Instrument Cover Sheet.docx	Yes	Yes	Paper Only
Form and Instruction	1.4	Survey	B.4 LOI3-MHLTH-09 Parental Mental Health Screen.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: 3,450

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	5,050	5,050
Annual IC Time Burden (Hours)	1,589	1,589
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
A.2 LOI2-QUEX-5 Exemplar Consent Form	A.2 LOI2-QUEX-5 Exemplar Consent Form.docx	06/19/2013
A.3 LOI2-QUEX-5 Exemplar Recuitment Cover Letter	A.3 LOI2-QUEX-5 Exemplar Recuitment Cover Letter.docx	06/19/2013
A.4 LOI2-QUEX-5 Exemplar Flyer	A.4 LOI2-QUEX-5 Exemplar Flyer.docx	06/19/2013
A.5 LOI2-QUEX-5 Bayley 3 Approved Project Protocol	A.5 LOI2-QUEX-5 Bayley 3 Approved Project Protocol.docx	06/19/2013
A.6 LOI2-QUEX-5 IRB Approval Letters	A.6 LOI2-QUEX-5 IRB Approval Letters.pdf	06/19/2013
B.1 LOI3-MHLTH-09 IRB Protocol	B.1 LOI3-MHLTH-09 IRB Protocol.docx	06/19/2013
B.2 LOI3-MHLTH-09 IRB Approval Letter	B.2 LOI3-MHLTH-09 IRB Approval Letter.pdf	06/19/2013
B.7 LOI3-MHLTH-09 Flyers	B.7 LOI3-MHLTH-09 Flyers.pdf	06/19/2013
B.8 LOI3-MHLTH-09 Brochures	B.8 LOI3-MHLTH-09 Brochures.pdf	06/19/2013
B.6 LOI3-MHLTH-09 Consent Form	B.6 LOI3-MHLTH-09 Consent Form.pdf	07/12/2013
LO12-QUEX-5 Baley3 Template	A. LOI2-QUEX-5 Bayley-3 OIRA Template 11182013 Revised.docx	11/22/2013
LO13-MHLTH-09 TEmplate	B. LOI3-MHLTH-09 OIRA Template 11182013 Revised.docx	11/22/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.