Request for Nonmaterial/Non-substantive Change to an OMB Approved Information Collection

ICR Non-Substantive CHANGE REQUEST MEMO

ICR Title

OMB NO. 0920-1382

Expiration Date 1/31/2026

Summary:

Edits to survey instrument (CH STRONG KIDS (Congenital Heart Survey to Recognize Outcomes, Needs, and wellbeinG of KIDS) to improve clarity and ensure that privacy standards are met for online data collection. Changes include:

• Deleting 2 questions

• Changing the response to one question asking age of caregiver from a numeric response to a categorical response

• Creating fewer categories as the responses for 6 questions

• Adding instructions to clarify skip patterns on the paper surveys only. Skip patterns are automated for the online surveys

Attachments:

Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG of KIDS

Attachment 4: English (paper)

Attachment 5: Spanish (paper)

Attachment 23: Somali (paper)

Attachment 24: English (online)

Attachment 25: Spanish (online)

Background & Justification:

Proposed changes to this project will result in improved clarity of surveys and confidentiality of data for participants.

Effect of Proposed Changes on Current Approved Instruments:

• Show a crosswalk of the changes in table below

Form	Current/Question Item	Requested Change
Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS	In what month and year was this child born?	Question removed from survey
	How are you related to this child? Biological or adoptive parent Step-parent Grandparent Foster parent Other: Relative Other: Non-relative	How are you related to this child? Biological, adoptive, or step parent Foster parent Other: Relative Other: Non-relative
	How is this other caregiver related to this child? Biological or adoptive parent Step-parent Grandparent Foster parent Other: Relative Other: Non-relative	How is this other caregiver related to this child? Biological, adoptive, or step parent Foster parent Other: Relative Other: Non-relative
	What is your age in years? _ _ _ Numeric response	What is your age in years? 19 or younger 20-29 30-39 40-49 50-59 60-69 70 or older
	What is your marital status? Married Not married, but living with partner Never married Divorced Separated Widowed	Question removed from survey
	What is the highest grade or level of school you have completed? 8th grade or less 9th-12th grade; No diploma High School Graduate or GED Completed Completed a vocational, trade, or business school program Associate Degree (AA, AS) Bachelor’s Degree (BA, BS, AB) Master’s Degree (MA, MS, MSW, MBA) Doctorate (PhD, EdD) or Professional Degree (MD, DDS, DVM, JD)	What is the highest grade or level of school you have completed? 12th grade or less; No diploma High School Graduate or GED Completed College Graduate or higher
	What is the highest grade or level of school this caregiver has completed? 8th grade or less 9th-12th grade; No diploma High School Graduate or GED Completed Completed a vocational, trade, or business school program Associate Degree (AA, AS) Bachelor’s Degree (BA, BS, AB) Master’s Degree (MA, MS, MSW, MBA) Doctorate (PhD, EdD) or Professional Degree (MD, DDS, DVM, JD)	What is the highest grade or level of school this caregiver has completed? 12th grade or less; No diploma High School Graduate or GED Completed College Graduate or higher
	Which of the following best describes your current employment status? Employed full time Employed part-time Working WITHOUT pay Not employed but looking for work Not employed and not looking for work	Which of the following best describes your current employment status? Employed full time Employed part-time Not employed or working WITHOUT pay
	Which of the following best describes this caregiver’s current employment status? Employed full time Employed part-time Working WITHOUT pay Not employed but looking for work Not employed and not looking for work	Which of the following best describes this caregiver’s current employment status? Employed full time Employed part-time Not employed or working WITHOUT pay
	Additions/edits to existing skip pattern language	Change “Go to” to “Skip to” throughout survey. Add the following new skip pattern instructions: “Skip to instructions before question 14.” “If you answered “Yes” to any questions in this section (questions 19-24), continue to question 25. Otherwise, skip to the next section.” “If your child is younger than 3 years old, skip to question 46. If your child is between 3 and 5 years old, skip to question 34. Otherwise, continue to Q26.” “If your child is younger than 12 years old, skip to question 31. Otherwise, continue to question 30.” “If your child is between 3 and 5 years old, continue to question 35. Otherwise, skip to question 46.” “If your child is at least 12 years old, continue to question 54. Otherwise, skip to question 60.”

Effect on Burden Estimate:

• No change to burden estimate

Form	Approved Burden	Requested Burden
Congenital Heart Survey To Recognize Outcomes, Needs, and wellbeinG of KIDS	Respondents: 2556 Hours: 852 Costs: $ 17,184.84	Respondents: 2556 Hours: 852 Costs: $ 17,184.84
Total
	Respondents: 2556 Hours: 852 Costs: $ 17,184.84	Respondents: 2556 Hours: 852 Costs: $ 17,184.84

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