OMB
.report
Search
Clinic Visit 1
Stress and Cortisol Measurement for the National Childrens Study (NICHD)
OMB: 0925-0671
IC ID: 203350
OMB.report
HHS/NIH
OMB 0925-0671
ICR 201301-0925-001
IC 203350
( )
Documents and Forms
Document Name
Document Type
Form 1.1
Clinic Visit 1
Form and Instruction
1.1 Survey
Attach 2. Screening Tool.docx
Form and Instruction
1.2 Form
Attach 4. Participant Contact Information Sheet.docx
Form
1.4 Survey
Attach 7.Visit 1 Stress Questionnaire.docx
Form and Instruction
1.5 Survey
Attach 10. SLES Checklist.pdf
Form and Instruction
1.3 Attach 6. Demographic and Health Survey
Attach 6. Demographic and Health Survey.docx
Form
Attach 15. Study Visit 1 Blood Requisition Form.docx
Attach 15. Study Visit 1 Blood Requisition Form
IC Document
Attach 17. Visit 1 Blood Processing Protocol.doc
Attach 17. Visit 1 Blood Processing Protocol
IC Document
Attach 14. Study Hair Collection Protocol.docx
Attach 14. Study Hair Collection Protocol
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Clinic Visit 1
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
1.1
Survey
Attach 2. Screening Tool.docx
Yes
Yes
Fillable Printable
Form
1.2
Form
Attach 4. Participant Contact Information Sheet.docx
Yes
Yes
Paper Only
Form and Instruction
1.4
Survey
Attach 7.Visit 1 Stress Questionnaire.docx
Yes
Yes
Paper Only
Form and Instruction
1.5
Survey
Attach 10. SLES Checklist.pdf
Yes
Yes
Paper Only
Form
1.3
Attach 6. Demographic and Health Survey
Attach 6. Demographic and Health Survey.docx
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
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:
700
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
700
0
700
0
0
0
Annual IC Time Burden (Hours)
972
0
972
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Attach 15. Study Visit 1 Blood Requisition Form
Attach 15. Study Visit 1 Blood Requisition Form.docx
12/06/2012
Attach 17. Visit 1 Blood Processing Protocol
Attach 17. Visit 1 Blood Processing Protocol.doc
12/06/2012
Attach 14. Study Hair Collection Protocol
Attach 14. Study Hair Collection Protocol.docx
12/06/2012
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.