60-Month Interview

Continuation of National Children's Study Vanguard (Pilot) Study Data Collection: Study Visits through 60-Months and Sibling Birth Enrollment

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0593 can be found here:

Documents and Forms

Document Name Document Type
Form 37.1 60-Month Interview Form and Instruction
37.1 Survey 60MonthASQ3.docx Form and Instruction
37.2 Survey SWANRatingScaleADHDSAQ.docx Form and Instruction
37.3 Survey EarlyChildHoodCognitionBattery_NIHToolbox.docx Form and Instruction
37.4 Survey MajorLifeEventsSAQ.docx Form and Instruction
37.5 Survey 60MQuestionnaireChild.docx Form and Instruction
37.6 Survey 60MQuestionnaire Adult.docx Form and Instruction
37.7 Survey 60MQuestionnaireHousehold.docx Form and Instruction
37.8 Survey 60MQuestionnaireChildCare.docx Form and Instruction
ASQ3InPersonMailInstructions.docx ASQ3InPersonMailInstructions IC Document
SWANBehaviorRatingScalesInstructions.docx SWANBehaviorRatingScalesInstructions IC Document
MajorLifeEventsInstructions.docx MajorLifeEventsInstructions IC Document
HIPAAHealthUseDisclosureAuthorizationForm.docx HIPAAHealthUseDisclosureAuthorizationForm IC Document
InformedConsentFormAdult.docx InformedConsentFormAdult IC Document
MultiModeVisitInformationScript.docx MultiModeVisitInformationScript IC Document
ParentalPermissionChildParticipation6MonthtoAgeMajority.docx ParentalPermissionChildParticipation6MonthtoAgeMajority IC Document
ReconsiderationQuestionnaireAdult.docx ReconsiderationQuestionnaireAdult IC Document
ReconsiderationQuestionnaireChild.docx ReconsiderationQuestionnaireChild IC Document
SampleCollectionVIS.docx SampleCollectionVIS IC Document

Information Collection (IC) Details

IC Title:	60-Month Interview	Agency IC Tracking Number:

Is this a Common Form? No		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	37.1	Survey	60MonthASQ3.docx	Yes	Yes	Paper Only
Form and Instruction	37.2	Survey	SWANRatingScaleADHDSAQ.docx	Yes	Yes	Paper Only
Form and Instruction	37.3	Survey	EarlyChildHoodCognitionBattery_NIHToolbox.docx	Yes	Yes	Paper Only
Form and Instruction	37.4	Survey	MajorLifeEventsSAQ.docx	Yes	Yes	Paper Only
Form and Instruction	37.5	Survey	60MQuestionnaireChild.docx	Yes	Yes	Paper Only
Form and Instruction	37.6	Survey	60MQuestionnaire Adult.docx	Yes	Yes	Paper Only
Form and Instruction	37.7	Survey	60MQuestionnaireHousehold.docx	Yes	Yes	Paper Only
Form and Instruction	37.8	Survey	60MQuestionnaireChildCare.docx	Yes	Yes	Paper Only

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: 1,332	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,332	1,332
Annual IC Time Burden (Hours)	1,903	1,903
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
ASQ3InPersonMailInstructions	ASQ3InPersonMailInstructions.docx	11/07/2013
SWANBehaviorRatingScalesInstructions	SWANBehaviorRatingScalesInstructions.docx	11/07/2013
MajorLifeEventsInstructions	MajorLifeEventsInstructions.docx	11/07/2013
HIPAAHealthUseDisclosureAuthorizationForm	HIPAAHealthUseDisclosureAuthorizationForm.docx	01/15/2014
InformedConsentFormAdult	InformedConsentFormAdult.docx	01/15/2014
MultiModeVisitInformationScript	MultiModeVisitInformationScript.docx	01/15/2014
ParentalPermissionChildParticipation6MonthtoAgeMajority	ParentalPermissionChildParticipation6MonthtoAgeMajority.docx	01/15/2014
ReconsiderationQuestionnaireAdult	ReconsiderationQuestionnaireAdult.docx	01/15/2014
ReconsiderationQuestionnaireChild	ReconsiderationQuestionnaireChild.docx	01/15/2014
SampleCollectionVIS	SampleCollectionVIS.docx	01/15/2014

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