Form 4.1 Survey

OMB #: 0925-0593

OMB Expiration Date: 08/31/2014

NIH Toolbox Emotion Battery, Phase 2g

NIH Toolbox Emotion Battery

Event Category:	Time-Based (18M, 42M) Trigger-Based (PV1)
Event:	PV1, 18M, 42M
Administration:	N/A
Instrument Target:	Pregnant Woman (PV1), Primary Caregiver (18M, 42M)
Instrument Respondent:	Pregnant Woman (PV1), Primary Caregiver (18M, 42M)
Domain:	Neuro-Psychosocial
Document Category:	Scored Assessment
Mode (for this instrument*):	In-Person, CAI
OMB Approved Modes:	Web-Based, CAI; In-Person, CAI
Method:	Data Collector Administered
Estimated Administration Time:	17 minutes
Multiple Child/Sibling Consideration:	Per Event
Special Considerations:	Trigger-Based: If respondent indicates she is pregnant in the Pregnancy Screener Sibling Birth Cohort
Version:	1.0
MDES Release:	4.0
Publisher:	NIH Toolbox
NCS Contact:	Carol Andreassen Westat 301-251-1500

*This instrument is OMB-approved for multi-mode administration but this version of the instrument is designed for administration in this/these mode(s) only.

Emotion Battery

The NIH Toolbox is a research-based battery of cognitive, sensory, motor, and emotional function measures that was developed and nationally normed for ages 3-85 (www.nihtoolbox.org). The Emotion Battery is a series of questionnaires the parent/caregiver completes about the child. This battery, designed for ages 8-85, includes measures of Psychological Well-Being, Social Relationships, Stress and Self-Efficacy, and Negative Affect.

The Psychological Well-Being domain includes questions about pleasure, positive affect, life satisfaction, and meaning and purpose. The Social Relationships domain includes questions about emotional support, empathetic behaviors, friendships, instrumental support, loneliness, perceived hostility, and perceived rejection. The Stress and Self-Efficacy domain includes questions about perceived stress, self-efficacy, and coping strategies. The Negative Affect domain includes questions about anger, fear, sadness, and apathy. The administration time is approximately 22 minutes for the battery.

Public reporting burden for this collection of information is estimated to average 17 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0593*). Do not return the completed form to this address.