Birth Interview

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0593 can be found here:

Documents and Forms

Document Name Document Type
Form 8.1 Birth Interview Form and Instruction
8.1 Survey BirthQuestionnaireAdult.docx Form and Instruction
8.2 Survey BirthQuestionnaireHousehold.docx Form and Instruction
8.3 Survey BirthQuestionnaireChild.docx Form and Instruction
BirthCertificateAuthorizationForm.doc BirthCertificateAuthorizationForm IC Document
HIPAAHealthUseDisclosureAuthorizationForm.docx HIPAAHealthUseDisclosureAuthorizationForm IC Document
HIPAAUseBiologicalSamplesAuthorizationForm.doc HIPAAUseBiologicalSamplesAuthorizationForm IC Document
MultiModeVisitInformationScript.docx MultiModeVisitInformationScript IC Document
ParentalPermissionChildParticipationBirthto6Months.docx ParentalPermissionChildParticipationBirthto6Months IC Document
SampleCollectionVIS.docx SampleCollectionVIS IC Document

Information Collection (IC) Details

IC Title:	Birth Interview	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	8.1	Survey	BirthQuestionnaireAdult.docx	Yes	Yes	Paper Only
Form and Instruction	8.2	Survey	BirthQuestionnaireHousehold.docx	Yes	Yes	Paper Only
Form and Instruction	8.3	Survey	BirthQuestionnaireChild.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: 317	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	317	-824	1,141
Annual IC Time Burden (Hours)	214	-166	380
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
BirthCertificateAuthorizationForm	BirthCertificateAuthorizationForm.doc	01/14/2014
HIPAAHealthUseDisclosureAuthorizationForm	HIPAAHealthUseDisclosureAuthorizationForm.docx	01/14/2014
HIPAAUseBiologicalSamplesAuthorizationForm	HIPAAUseBiologicalSamplesAuthorizationForm.doc	01/14/2014
MultiModeVisitInformationScript	MultiModeVisitInformationScript.docx	01/14/2014
ParentalPermissionChildParticipationBirthto6Months	ParentalPermissionChildParticipationBirthto6Months.docx	01/14/2014
SampleCollectionVIS	SampleCollectionVIS.docx	01/14/2014

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