Core Questionnaire - Child, Adult, & Household

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

Documents and Forms

Document Name Document Type
Form 26.2 Core Questionnaire - Child, Adult, & Household Form and Instruction
26.2 Survey CoreQuestionnaireAdult.docx Form and Instruction
26.3 Survey CoreQuestionnaireHousehold.docx Form and Instruction
26.1 Revised Survey CoreQuestionnaireChild_REVISED.docx Form and Instruction
VaccinationGridCoreModule.docx VaccinationGridCoreModule IC Document

Information Collection (IC) Details

IC Title:	Core Questionnaire - Child, Adult, & Household	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	26.2	Survey	CoreQuestionnaireAdult.docx	Yes	Yes	Paper Only
Form and Instruction	26.3	Survey	CoreQuestionnaireHousehold.docx	Yes	Yes	Paper Only
Form and Instruction	26.1 Revised	Survey	CoreQuestionnaireChild_REVISED.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: 1,107	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	9,963	9,963
Annual IC Time Burden (Hours)	5,646	5,646
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
VaccinationGridCoreModule	VaccinationGridCoreModule.docx	11/08/2013

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