12-Month Interview

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

OMB: 0925-0593

IC ID: 193577

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

12-Month Interview
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 14.1 Survey 12MonthASQ3.docx Yes Yes Paper Only
Form and Instruction 14.2 Survey 12M_14MonthASQ3.docx Yes Yes Paper Only
Form and Instruction 14.3 Survey 12M_16MonthASQ3.docx Yes Yes Paper Only
Form and Instruction 14.4 Survey BriefInfantToddlerSocialEmotionalAssessmentSAQ.docx Yes Yes Paper Only
Form and Instruction 14.5 Survey 12MonthQuestionnaireChild.docx Yes Yes Paper Only
Form and Instruction 14.6 Survey 12MonthQuestionnaireAdult.docx Yes Yes Paper Only
Form and Instruction 14.7 Survey 12MonthSAQChild.docx Yes Yes Paper Only
Form and Instruction 14.8 Survey 12MonthSAQAdult.docx Yes Yes Paper Only
Form and Instruction 14.9 Survey 12MonthQuestionnaireHousehold.docx Yes Yes Paper Only

General Science and Innovation Scientific and Technological Research and Innovation

 

554 0
   
Individuals or Households
 
   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 554 0 0 0 0 554
Annual IC Time Burden (Hours) 478 0 0 0 0 478
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
HIPAAHealthUseDisclosureAuthorizationForm HIPAAHealthUseDisclosureAuthorizationForm.docx 01/14/2014
ASQ3InPersonMailInstructions ASQ3InPersonMailInstructions.docx 01/15/2014
BITSEAInPersonMailInstructions BITSEAInPersonMailInstructions.docx 01/15/2014
BITSEAPhoneInstructions BITSEAPhoneInstructions.docx 01/15/2014
InformedConsentFormAdult Attach 10. Informed Consent Form - Adult.docx 07/24/2014
ParentalPermissionChildParticipation6MonthtoAgeMajority Attach 12. Parental Permission Child Participation - Birth to 6Months.docx 07/24/2014
MultiModeVisitInformationScript Attach 13. Multi-Mode Visit Information Script.docx 07/24/2014
SampleCollectionVIS Attach 14. Sample Collection Visit Information Sheet Scripts.docx 07/24/2014
ReconsiderationQuestionnaireAdult Attach 19. Reconsideration Questionnaire Adult.docx 07/24/2014
ReconsiderationQuestionnaireChild Attach 20. Reconsideration Questionnaire Child.docx 07/24/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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