Child Health Disparities Substudy for the National Children's Study (NCS)- Phase 1

Forms and Documents

Document Name	Status
Form 2.1 Cognitive Interview Guide Form and Instruction	New
Form 1.1 Cognitive Interview Screener Form and Instruction	New
NCS Child Health Disparities Phase I SSB 20130131.docx Supporting Statement B	2013-02-13
Attach 9. IRB Protocol Child Health Disparities.docx Supplementary Document	2013-02-14
Attach 8. Continuing Review IRB Approval Child Health Disparities.pdf Supplementary Document	2013-02-14
Attach 7. Consent for Cognitive Interview.pdf Supplementary Document	2013-02-14
Attach 1. Exemplar Recruitment Flyer.docx Supplementary Document	2013-02-13
Attach 10. Note to File.docx Supplementary Document	2013-02-14
Attach 4. Newest Vital Sign Food Label.pdf Supplementary Document	2013-02-14
NCS Child Health Disparities Phase I SSA 20130131.docx Supporting Statement A	2013-02-13

IC Document Collections

IC ID	Document Title	Status
206117	Cognitive Interview Guide Form and Instruction	New
206116	Cognitive Interview Screener Form and Instruction	New

ICR Details

OMB Control No: 0925-0673	ICR Reference No: 201303-0925-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/NIH	Agency Tracking No: 18812
Title: Child Health Disparities Substudy for the National Children's Study (NCS)- Phase 1
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/15/2013
	Date Received in OIRA: 03/13/2013
Terms of Clearance: Only Phase I - cognitive interviewing to test content validity - is approved. A substantive change request is required for Phase II.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2015	36 Months From Approved
Responses	160	0	0
Time Burden (Hours)	68	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Phase I of the Child Health Disparities Substudy will involve conducting cognitive tests for content validity. The testing will focus on measures of health disparities, specifically health literacy, discrimination, stress and education level in mothers of small children across diverse populations.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 15780	03/16/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 38840	06/29/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Cognitive Interview Screener	1.1, 1.2, 1.3	Survey ,   Survey ,   Survey
Cognitive Interview Guide	2.1	Survey

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	160	0	0	160	0	0
Annual Time Burden (Hours)	68	0	0	68	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a request for a new data collection.

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Annual Cost to Federal Government: $247,374

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/13/2013

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