Testing of automated self-response methods for collecting the reduced content version of NCS pregnancy status follow-up contacts

National Children's Study Formative Generic Clearance

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0590 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Testing of automated self-response methods for collecting the reduced content version of NCS pregnancy status follow-up contacts Form and Instruction
1 survey 3. Appendix A - NCS Formative Research Recruiting Questionnaire - Automated self-response.docx Form and Instruction
2 survey 7. Appendix E - Pregnancy Screener for self-response test.docx Form and Instruction
3 survey 8.Appendix F - Consent Form to Receive Text Messages.docx Form and Instruction
4 survey 9. Appendix G - Interactive Voice Response Phone Follow-up Script.docx Form and Instruction
5 survey 11. Appendix I - Web E-mail Follow-up Script.docx Form and Instruction
6 survey 10. Appendix H - Text Message Follow-up Script.docx Form and Instruction
2. Automated Self-response Formative Research Cover Memo.docx 2 IC Document
1 Submission of Information Collection - Automated Self-response (2).doc 1 Submission of Information Collection - Automated Self-response (2) IC Document
4. Appendix B - Flowchart for 6-week Contact.pdf 4 IC Document
5. Appendix C - Flowchart for 12-week Contact.pdf 5 IC Document
6. Appendix D - Consent Form for Westat Formative Research Study.docx 6 IC Document
12. Appendix J - Westat IRB Expedited Approval.docx 12 IC Document
0925-0590 Terms of Clearance.doc Terms of Clearance IC Document

Information Collection (IC) Details

IC Title:	Testing of automated self-response methods for collecting the reduced content version of NCS pregnancy status follow-up contacts	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	survey	3. Appendix A - NCS Formative Research Recruiting Questionnaire - Automated self-response.docx	Yes	Yes	Paper Only
Form and Instruction	2	survey	7. Appendix E - Pregnancy Screener for self-response test.docx	Yes	Yes	Paper Only
Form and Instruction	3	survey	8.Appendix F - Consent Form to Receive Text Messages.docx	Yes	Yes	Paper Only
Form and Instruction	4	survey	9. Appendix G - Interactive Voice Response Phone Follow-up Script.docx	Yes	Yes	Paper Only
Form and Instruction	5	survey	11. Appendix I - Web E-mail Follow-up Script.docx	Yes	Yes	Paper Only
Form and Instruction	6	survey	10. Appendix H - Text Message Follow-up Script.docx	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 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	200	0	0	0	0	0
Annual IC Time Burden (Hours)	100	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
2	2. Automated Self-response Formative Research Cover Memo.docx	07/16/2009
1 Submission of Information Collection - Automated Self-response (2)	1 Submission of Information Collection - Automated Self-response (2).doc	07/16/2009
4	4. Appendix B - Flowchart for 6-week Contact.pdf	07/16/2009
5	5. Appendix C - Flowchart for 12-week Contact.pdf	07/16/2009
6	6. Appendix D - Consent Form for Westat Formative Research Study.docx	07/16/2009
12	12. Appendix J - Westat IRB Expedited Approval.docx	07/16/2009
Terms of Clearance	0925-0590 Terms of Clearance.doc	09/18/2009

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