Information Collection

Assessment of Executive Function for the National Children's Study

IC 212511 under ICR 201412-0925-001 · OMB 0925-0661.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 1
Assessment of Executive Function for the National Children's Study
Form and Instruction
Attach 17 Consent Form Delve with no 2nd session.docx Other-Consent
Attach 19 Consent Form UofM with no 2nd session.docx Other-Consent
Attach 26 Child Assent Form.docx Other-Assent
Attach 16 Consent Form Delve with 2nd session.docx Other-Consent 2
Attach 18 Consent Form UofM with 2nd session.docx Other-Consent 2
Attach 26 Child Assent Form.docx Other-Consent 2
1 Recruitment Screening Interview
Attach 15 Recruitment Screening Script.docx
Form and Instruction
2 Family Demographic Questionnaire
Attach 9 Family Demographic Questionnaire_FINAL.docx
Form and Instruction
3 CBQ-VSF+EF
Attach 10 CBQ-VSF+EF.docx
Form and Instruction
4 Ages and Stages Social Emotional Questionnaire
Attach 11 Ages and Stages Social Emotional Questionanaire.docx
Form and Instruction
5 Strengths and Difficulties Questionnaire
Attach 12 Strengths and Difficulties Questionnaire.docx
Form and Instruction
6 Q-ABC
Attach 13 Q-ABC.docx
Form and Instruction
7 Touch Screen Tutorial
Attach 1 Touch Screen Tutorial.docx
Form and Instruction
8 Dimensional Change Card Sort Test
Attach 2 Dimensional Change Card Sort Test.docx
Form and Instruction
9 Flanker Inhibitory Control and Attention Test
Attach 3 Flanker Inhibitory Control and Attention Test.docx
Form and Instruction
10 Picture Vocabulary Test
Attach 4 Picture Vocabulary Test.docx
Form and Instruction
11 Picture Sequence Memory Test
Attach 5 Picture Sequence Memory Test.docx
Form and Instruction
12 Peg Tapping
Attach 6 Peg Tapping.docx
Form and Instruction
13 WPPSI-IV Block Design
Attach 7 WPPSI-IV Block Design.docx
Form and Instruction
12 Woodcock-Johnson III Tests of Achievement
Attach 8 Woodcock Johnson III.docx
Form and Instruction
Attach 14 Letter of Invitation.docx
Letter of Invitation
IC Document
Attach 20 Univ of Minnesota IRB Original Application 01052011.pdf
Univ of Minnesota IRB Original Application 01052011
IC Document
Attach 21 Univ of Minnesota IRB Annual Renewal Approval 03062014.pdf
Univ of Minnesota IRB Annual Renewal Approval 03062014
IC Document
Attach 22 Univ of Minnesota IRB Change in Protocol Request 11062013.docx
Univ of Minnesota IRB Change in Protocol Request 11062013
IC Document
Attach 23 Univ of Minnesota IRB Change in Protocol Approval 11132013.pdf
Univ of Minnesota IRB Change in Protocol Approval 11132013
IC Document
Attach 24 Delve IRB Letter.pdf
Delve IRB Letter
IC Document
Attach 25 Northwestern Univ IRB Letter.pdf
Northwestern Univ IRB Letter
IC Document
Attach 27 Univ of Minnesota IRB Change in Protocol Approval 06062014.pdf
Univ of Minnesota IRB Change in Protocol Approval 06062014
IC Document
Executive_Function_LOI2-QUEX-6_OIRA_Template_FINAL Nov 2014.docx
OMB Request 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 Recruitment Screening Interview Attach 15 Recruitment Screening Script.docx Yes Yes Fillable Fileable
Other-Consent Attach 17 Consent Form Delve with no 2nd session.docx Yes Yes Fillable Fileable Signable
Other-Consent Attach 19 Consent Form UofM with no 2nd session.docx Yes Yes Fillable Fileable Signable
Other-Assent Attach 26 Child Assent Form.docx Yes Yes Fillable Fileable Signable
Form and Instruction 2 Family Demographic Questionnaire Attach 9 Family Demographic Questionnaire_FINAL.docx Yes Yes Fillable Fileable
Form and Instruction 3 CBQ-VSF+EF Attach 10 CBQ-VSF+EF.docx Yes Yes Fillable Fileable
Form and Instruction 4 Ages and Stages Social Emotional Questionnaire Attach 11 Ages and Stages Social Emotional Questionanaire.docx Yes Yes Fillable Fileable
Form and Instruction 5 Strengths and Difficulties Questionnaire Attach 12 Strengths and Difficulties Questionnaire.docx Yes Yes Fillable Fileable
Form and Instruction 6 Q-ABC Attach 13 Q-ABC.docx Yes Yes Fillable Fileable
Form and Instruction 7 Touch Screen Tutorial Attach 1 Touch Screen Tutorial.docx Yes Yes Fillable Fileable
Form and Instruction 8 Dimensional Change Card Sort Test Attach 2 Dimensional Change Card Sort Test.docx Yes Yes Fillable Fileable
Form and Instruction 9 Flanker Inhibitory Control and Attention Test Attach 3 Flanker Inhibitory Control and Attention Test.docx Yes Yes Fillable Fileable
Form and Instruction 10 Picture Vocabulary Test Attach 4 Picture Vocabulary Test.docx Yes Yes Fillable Fileable
Form and Instruction 11 Picture Sequence Memory Test Attach 5 Picture Sequence Memory Test.docx Yes Yes Fillable Fileable
Form and Instruction 12 Peg Tapping Attach 6 Peg Tapping.docx Yes Yes Fillable Fileable
Form and Instruction 13 WPPSI-IV Block Design Attach 7 WPPSI-IV Block Design.docx Yes Yes Fillable Fileable
Form and Instruction 12 Woodcock-Johnson III Tests of Achievement Attach 8 Woodcock Johnson III.docx Yes Yes Fillable Fileable
Other-Consent 2 Attach 16 Consent Form Delve with 2nd session.docx Yes Yes Fillable Fileable Signable
Other-Consent 2 Attach 18 Consent Form UofM with 2nd session.docx Yes Yes Fillable Fileable Signable
Other-Consent 2 Attach 26 Child Assent Form.docx Yes Yes Fillable Fileable Signable

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 792 0 0 0 0 792
Annual IC Time Burden (Hours) 814 0 0 0 0 814
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Letter of Invitation Attach 14 Letter of Invitation.docx 07/29/2014
Univ of Minnesota IRB Original Application 01052011 Attach 20 Univ of Minnesota IRB Original Application 01052011.pdf 07/29/2014
Univ of Minnesota IRB Annual Renewal Approval 03062014 Attach 21 Univ of Minnesota IRB Annual Renewal Approval 03062014.pdf 07/29/2014
Univ of Minnesota IRB Change in Protocol Request 11062013 Attach 22 Univ of Minnesota IRB Change in Protocol Request 11062013.docx 07/29/2014
Univ of Minnesota IRB Change in Protocol Approval 11132013 Attach 23 Univ of Minnesota IRB Change in Protocol Approval 11132013.pdf 07/29/2014
Delve IRB Letter Attach 24 Delve IRB Letter.pdf 07/29/2014
Northwestern Univ IRB Letter Attach 25 Northwestern Univ IRB Letter.pdf 07/29/2014
Univ of Minnesota IRB Change in Protocol Approval 06062014 Attach 27 Univ of Minnesota IRB Change in Protocol Approval 06062014.pdf 07/29/2014
OMB Request Template Executive_Function_LOI2-QUEX-6_OIRA_Template_FINAL Nov 2014.docx 11/12/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.