MajorLifeEventsInstructions

OMB #: 0925-0593

OMB Expiration Date: 08/31/2014

Neuro-Psychosocial Major Life Events Instructions, Phase 2g

The National Children’s Study

Major Life Events

Instructions

Questionnaire

Thank you for agreeing to participate in the National Children’s Study (NCS) and completing the Major Life Events questionnaire. This questionnaire will take about 8 minutes to complete. It includes questions about life changing events you may have experienced in the last year, and, if so, what impact did the event(s) have on you. You may use a pencil or pen to record your answers.

Your answers are important to us. We will keep everything that you tell us confidential.

Listed below are several points that you may find helpful in completing the questionnaire:

• For each item, please indicate whether you have experienced that type of event within the past year.

• If you have experienced an event, then next please rate the impact that event has had on your life. That is, did the event have an extremely, moderately, or somewhat negative or bad impact, an extremely, moderately, or somewhat positive or good impact, or no impact at all.

• There are no right or wrong answers, what matters is your experience over the past 1 year.

• Please try not to skip any items and please select only one impact rating for each item.

• If you change your mind about an answer, strike through your original answer and then select your new answer.

• After completing the questionnaire, please review it to make sure that you have answered all of the items and that there is only one impact rating for each item.

• To return the questionnaire to the Regional Operations Center (ROC), please follow the instructions printed on the next page.

If you have any questions, please call the local contact number located on the last page.

Thank you for taking the time to complete this questionnaire!

For Office Use Only:

Instructions for returning the questionnaire to the Regional Operations Center (ROC):

{Local instructions inserted by ROC. Provide the parent/caregiver with ROC-specific instructions for returning the questionnaire to the ROC here, such as instructions about the data collector retrieving the questionnaire at the in-person visit.}

Insert ROC contact information label here.

NEU Major Life Events Instructions, MDES 4.0, V1.0 1