Pregnancy Visit 1 Interview

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

OMB: 0925-0593

IC ID: 193565

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Pregnancy Visit 1 Interview
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 4.1 Survey EmotionBattery_NIHToolbox.docx Yes Yes Paper Only
Form and Instruction 4.2 Survey PV1QuestionnnaireHousehold.docx Yes Yes Paper Only
Form and Instruction 4.4 Survey PV1SAQ.docx Yes Yes Paper Only
Form and Instruction 4.3 Survey PV1QuestionnaireAdult.docx Yes Yes Paper Only

General Science and Innovation Scientific and Technological Research and Innovation

 

333 0
   
Individuals or Households
 
   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 333 0 0 0 0 333
Annual IC Time Burden (Hours) 481 0 0 0 0 481
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
HIPAAHealthUseDisclosureAuthorizationForm HIPAAHealthUseDisclosureAuthorizationForm.docx 01/14/2014
InformedConsentFormPregnantWoman Attach 8. Informed Consent Form - Pregnant Woman.docx 07/24/2014
ParentalPermissionChildParticipationBirthto6Months Attach 11. Parental Permission Child Participation-6MtoAgeofMajority.docx 07/24/2014
MultiModeVisitInformationScript Attach 13. Multi-Mode Visit Information Script.docx 07/24/2014
SampleCollectionVIS Attach 14. Sample Collection Visit Information Sheet Scripts.docx 07/24/2014
HIPAAUseBiologicalSamplesAuthorizationForm Attach 15. HIPAA Authorization to Obtain Bodily Fluids and Tissues.docx 07/24/2014
ReconsiderationQuestionnaireAdult Attach 19. Reconsideration Questionnaire Adult.docx 07/24/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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