Attach B25. Participant Verification Birth Cohort

Provider-Based Sampling Feasibility Study for the Vanguard (Pilot) Study and Data Collection Updates for the National Children's Study (NICHD)

Attach B25. Participant Verification Birth Cohort

Formative - Developmental

OMB: 0925-0593

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OMB #: 0925-0593

OMB Expiration Date: 08/31/2014

PBS Participant Verification Birth Cohort Interview, Phase 2e




PBS Participant Verification Birth Cohort Interview

Event:

Birth

Participant:

Perinatal Woman

Respondent:

Perinatal Woman

Domain:


Questionnaire

Type of Document:


Interview

Allowable Mode:


In-person (CAPI), Telephone (CATI)


Allowable Method:


Interviewer-Administered

Recruitment Groups:

PBS

Version:

1.0

Release:


MDES 3.2








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PBS Participant Verification Birth Cohort Interview

TABLE OF CONTENTS



PBS Participant Verification Birth Cohort Interview


GENERAL PROGRAMMER INSTRUCTIONS

WHEN PROGRAMMING INSTRUMENTS, VALIDATE FIELD LENGTHS AND TYPES AGAINST THE MDES TO ENSURE DATA COLLECTION RESPONSES DO NOT EXCEED THOSE OF THE MDES. SOME GENERAL ITEM LIMITS USED ARE AS FOLLOWS:


DATA ELEMENT FIELDS

MAXIMUM CHARACTERS PERMITTED

PROGRAMMER INSTRUCTIONS

ADDRESS AND EMAIL FIELDS

100


UNIT AND PHONE FIELDS

10


_OTH AND COMMENT FIELDS

255


FIRST NAME, MIDDLE NAME, AND LAST NAME

30


ALL ID FIELDS

36


ZIP CODE

5


ZIP CODE LAST FOUR

4


CITY

50


DOB AND ALL OTHER DATE FIELDS (E.G., DT, DATE, ETC.)

10

  • DISPLAY AS MM/DD/YYYY

  • STORE AS YYYY-MM-DD

  • HARD EDITS:

MM MUST EQUAL 00 TO 12

DD MUST EQUAL 01 TO 31

YYYY MUST BE BETWEEN 1900 AND CURRENT YEAR.

TIME VARIABLES

TWO-DIGIT HOUR AND TWO-DIGIT MINUTE, AM/PM DESIGNATION

  • HARD EDITS:

HOURS MUST BE BETWEEN 00 AND 12;

MINUTES MUST BE BETWEEN 00 AND 59


Instrument Guidelines for Participant IDs:

THE P_ID IN THE MDES HEADER IS THAT OF THE PARTICIPANT (E.G. THE PERINATAL WOMAN).

PBS PARTICIPANT VERIFICATION BIRTH COHORT INTERVIEW


(TIME_STAMP_PBC_ST). PROGRAMMER INSTRUCTION:

  • INSERT DATE/TIME STAMP.

  • PRELOAD P_ID AND P_TYPE.

  • THIS INTERVIEW ONLY ADMINISTERED IF P_TYPE = 15.


PBC010/(MULT_CHILD). IS THERE MORE THAN ONE CHILD ELIGIBLE FOR THE BIRTH INTERVIEW TODAY?


INTERVIEWER INSTRUCTION:

  • DO NOT ADMINISTER THIS ITEM TO THE PARENT/CAREGIVER.


YES 1

NO 2 (C_FNAME)(C_LNAME)


PROGRAMMER INSTRUCTION:

  • IF MULT_CHILD = 2, SET CHILD_QNUM = 1.


PBC020/(CHILD_NUM). HOW MANY CHILDREN ARE ELIGIBLE FOR THE BIRTH INTERVIEW TODAY?


INTERVIEWER INSTRUCTION:

  • DO NOT ADMINISTER THIS ITEM TO THE PARENT/CAREGIVER.


|___|___|

NUMBER OF CHILDREN


PBC030/(CHILD_QNUM). WHICH NUMBER CHILD IS THIS QUESTIONNAIRE LOOP FOR?


INTERVIEWER INSTRUCTION:

  • DO NOT ADMINISTER THIS ITEM TO THE PARENT/CAREGIVER.

  • ENTER “1” AT BEGINNING OF INTERVIEW FOR FIRST CHILD.


|___|___|

NUMBER


PROGRAMMER INSTRUCTIONS:

  • CHILD_QNUM CANNOT BE GREATER THAN CHILD_NUM.


PBC040/(C_FNAME)(C_LNAME). What is the child’s full name?


INTERVIEWER INSTRUCTIONS:

  • IF PARENT/CAREGIVER REFUSES TO PROVIDE INFORMATION, RE-STATE CONFIDENTIALITY PROTECTIONS, ASK FOR INITIALS OR SOME OTHER NAME TO CALL THE CHILD.

  • CONFIRM SPELLING OF FIRST NAME IF NOT PREVIOUSLY COLLECTED AND OF LAST NAME.


_____________________ _____________________

FIRST NAME LAST NAME


REFUSED -1

DON’T KNOW -2


PBC050/(CHILD_SEX). What is the child’s sex?


MALE 1

FEMALE 2

REFUSED -1

DON’T KNOW -2


PBC060/(RESP_GUARD). Are you {C_FNAME/the child}’s legal guardian?



INTERVIEWER INSTRUCTIONS:

  • IF THE BIOLOGICAL MOTHER IS THE LEGAL GUARDAIN CONTINUE VISIT.

  • IF THE BIOLOGICAL MOTHER IS NOT THE LEGAL GUARDIAN OR SHE ANSWERS REFUSED OR DON’T KNOW, THEN THANK HER FOR HER TIME AND END THE VISIT.


YES 1

NO 2

REFUSED -1

DON’T KNOW -2



PROGRAMMER INSTRUCTIONS:

  • IF MULT_CHILD = 2, GO TO TIME_STAMP_PBC_ET.

  • IF MULT_CHILD = 1 AND

    • IF CHILD_QNUMCHILD_NUM, GO TO CHILD_QNUM AND INCREMENT BY ONE.

    • IF CHILD_QNUM = CHILD_NUM, GO TO TIME_STAMP_PBC_ET.


(TIME_STAMP_PBC_ET). PROGRAMMER INSTRUCTION:

  • INSERT DATE/TIME STAMP.


Public reporting burden for this collection of information is estimated to average 2 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.

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