OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Longitudinal follow-up of Youth with Attention-Deficit/Hyperactivity Disorder identified in Community Settings: Examining Health Status, Correlates, and Effects associated with treatment for ADHD

ICR 200704-0920-003 · OMB 0920-0747 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Attachment B35. Teachery Survery (Teacher) Form and Instruction New Repair queued
Attachment B34. Youth Demographic Survey (16+ years) (Child) Form and Instruction New Repair queued
Attachment B33. People In My Life/Inventory of Parent and Peer Attachment Form and Instruction New Repair queued
Attachment B32. People In My Life (Child) Form and Instruction New Available
Attachment B31. Pediatric Quality of Life (teen) (Child) Form and Instruction New Repair queued
Attachment B30. Pediatric Quality of Life (child) (Child) Form and Instruction New Available
Attachment B29. Pediatric Quality of Life (young child) (Child) Form and Instruction New Repair queued
Attachment B28. MARSH Self Description Questionnaire (16+ years) (Child) Form and Instruction New Available
Attachment B27. MARSH Self Description Questionnaire (13-15 years) (Child) Form and Instruction New Available
Attachment B26. MARSH Self Description Questionnaire (7-12 years) (Child) Form and Instruction New Repair queued
Attachment B25. Health Risk Behavior Survey (high school) (Child) Form and Instruction New Repair queued
Attachment B24. Health Risk Behavior Survey (middle school) (Child) Form and Instruction New Repair queued
Attachment B23. Health Risk Behavior Survey (elementary) (Child) Form and Instruction New Repair queued
Attachment B22. Brief Sensation Seeking Scale (11+ years) (Child) Form and Instruction New Available
Attachment B21. Vanderbilt Parent Rating Scale (Parent) Form and Instruction New Available
Attachment B20. Strengths and Difficulties Questionnaire (11-17) (Parent) Form and Instruction New Repair queued
Attachment B19. Strengths and Difficulties Questionnaire (4-10) (Parent) Form and Instruction New Available
Attachment B18. Social Isolation/Support (Parent) Form and Instruction New Available
Attachment B17. Quarterly Update Events and Demographics (Parent) Form and Instruction New Available
Attachment B16. Pediatric Quality of Life (teen) (Parent) Form and Instruction New Repair queued
Attachment B15. Pediatric Quality of Life (child) (Parent) Form and Instruction New Available
Attachment B14. Pediatric Quality of Life (young child) (Parent) Form and Instruction New Available
Attachment B13. Parents' Questionnaire (Mental Health History) (Parent) Form and Instruction New Available
Attachment B12. Parent-Child Relationship Inventory (Parent) Form and Instruction New Available
Attachment B11. Health Risk Behavior Survey (high school) (Parent) Form and Instruction New Available
Attachment B10. Health Risk Behavior Survey (middle school) (Parent) Form and Instruction New Repair queued
Attachment B9. Health Risk Behavior Survey (elementary) (Parent) Form and Instruction New Repair queued
Attachment B8. Demographic Survey (Parent) Form and Instruction New Repair queued
Attachment B7. Critical School Events (high school) (Parent) Form and Instruction New Repair queued
Attachment B6. Critical School Events (elementary, middle) (Parent) Form and Instruction New Available
Attachment B5. Brief Impairment Scale (Parent) Form and Instruction New Available
Attachment B4b. ADHD Treatment Quarterly Update (Parent) Form and Instruction New Available
Attachment B4a. ADHD Treatment, Cost, and Client Satisfaction Questionnaire (Parent) Form and Instruction New Repair queued
Attachment B3. ADHD Communication and Knowledge Scan (Parent) Form and Instruction New Available
Attachment B36-10 DISC MHM.pdf Supplementary Document Uploaded 2007-07-16 Repair queued
Attachment B36-9 DISC MDD.pdf Supplementary Document Uploaded 2007-07-16 Available
Attachment B36-8 DISC TIC.pdf Supplementary Document Uploaded 2007-07-16 Available
Attachment B36-7 DISC PTSD.pdf Supplementary Document Uploaded 2007-07-16 Repair queued
Attachment B36-6 DISC OCD.pdf Supplementary Document Uploaded 2007-07-16 Repair queued
Attachment B36-5 DISC GAD.pdf Supplementary Document Uploaded 2007-07-16 Available
Attachment B36-4 DISC CD.pdf Supplementary Document Uploaded 2007-07-16 Available
Attachment B36-3 DISC ODD.pdf Supplementary Document Uploaded 2007-07-16 Available
Attachment B36-2 DISC ADHD.pdf Supplementary Document Uploaded 2007-07-16 Available
Attachment B36-1 DISC intro.pdf Supplementary Document Uploaded 2007-07-16 Available
Attachment B36 DISC-IV Table of Contents.doc Supplementary Document Uploaded 2007-07-16 Available
Long-term Justification List of Attachments final.doc Supplementary Document Uploaded 2007-07-16 Available
Response to OMB desk officer concerns.doc Supplementary Document Uploaded 2007-07-16 Available
Long-term Justification B1-5 final.doc Supporting Statement B Uploaded 2007-07-16 Available
Attachment I2 Kaufman Brief Intelligence.pdf Supplementary Document Uploaded 0000-00-00 Repair queued
Attachment I1 DISC description.pdf Supplementary Document Uploaded 0000-00-00 Available
Attachment H2 SC Triage Protocol Document 3-13-07.doc Supplementary Document Uploaded 0000-00-00 Available
Attachment H1 OK Triage Protocol Document 3-13-07.doc Supplementary Document Uploaded 0000-00-00 Repair queued
Attachment G2 Respondent Break Down Tables with DISC final.doc Supplementary Document Uploaded 2007-07-16 Available
Attachment G1 sample description.doc Supplementary Document Uploaded 0000-00-00 Repair queued
Attachment F Certificate advisement language.doc Supplementary Document Uploaded 0000-00-00 Repair queued
Attachment E4 SC Child Assent age 9-18 3-13-07.doc Supplementary Document Uploaded 0000-00-00 Repair queued
Attachment E3 SC Child Assent age 7-8 3-13-07.doc Supplementary Document Uploaded 0000-00-00 Available
Attachment E2 SC Parental Consent age 9-18 3-13-07.doc Supplementary Document Uploaded 0000-00-00 Available
Attachment E1 SC Parent Consent (age 7-8) final.doc Supplementary Document Uploaded 2007-07-16 Repair queued
Attachment D3 OK Child Assent age 11-17 3-13-07.doc Supplementary Document Uploaded 0000-00-00 Repair queued
Attachment D2 OK Child Assent age 7-10 3-13-07.doc Supplementary Document Uploaded 0000-00-00 Available
Attachment D1 OK Parent Consent final.doc Supplementary Document Uploaded 2007-07-16 Available
Attachment C2 South Carolina IRB notice.pdf Supplementary Document Uploaded 0000-00-00 Repair queued
Attachment C1 Oklahoma IRB notice.pdf Supplementary Document Uploaded 0000-00-00 Repair queued
Attachment B2 Instrument descriptions final.doc Supplementary Document Uploaded 2007-07-16 Available
Attachment B1 Instrument Table final.doc Supplementary Document Uploaded 2007-07-16 Repair queued
Attachment A3 final 60 day notice.pdf Supplementary Document Uploaded 0000-00-00 Available
Attachment A2 Children's Health Act 2000.pdf Supplementary Document Uploaded 0000-00-00 Available
Attachment A1 Public Health Service Act 2000.pdf Supplementary Document Uploaded 0000-00-00 Repair queued
Long-term Justification A1-18 final.doc Supporting Statement A Uploaded 2007-07-16 Available
IC Document Collections
IC IDCollectionTypeStatusForm
179858 Attachment B35. Teachery Survery (Teacher) Form and Instruction New
179857 Attachment B34. Youth Demographic Survey (16+ years) (Child) Form and Instruction New
179856 Attachment B33. People In My Life/Inventory of Parent and Peer Attachment Form and Instruction New
179855 Attachment B32. People In My Life (Child) Form and Instruction New
179854 Attachment B31. Pediatric Quality of Life (teen) (Child) Form and Instruction New
179853 Attachment B30. Pediatric Quality of Life (child) (Child) Form and Instruction New
179852 Attachment B29. Pediatric Quality of Life (young child) (Child) Form and Instruction New
179851 Attachment B28. MARSH Self Description Questionnaire (16+ years) (Child) Form and Instruction New
179850 Attachment B27. MARSH Self Description Questionnaire (13-15 years) (Child) Form and Instruction New
179849 Attachment B26. MARSH Self Description Questionnaire (7-12 years) (Child) Form and Instruction New
179848 Attachment B25. Health Risk Behavior Survey (high school) (Child) Form and Instruction New
179847 Attachment B24. Health Risk Behavior Survey (middle school) (Child) Form and Instruction New
179846 Attachment B23. Health Risk Behavior Survey (elementary) (Child) Form and Instruction New
179845 Attachment B22. Brief Sensation Seeking Scale (11+ years) (Child) Form and Instruction New
179844 Attachment B21. Vanderbilt Parent Rating Scale (Parent) Form and Instruction New
179843 Attachment B20. Strengths and Difficulties Questionnaire (11-17) (Parent) Form and Instruction New
179842 Attachment B19. Strengths and Difficulties Questionnaire (4-10) (Parent) Form and Instruction New
179841 Attachment B18. Social Isolation/Support (Parent) Form and Instruction New
179840 Attachment B17. Quarterly Update Events and Demographics (Parent) Form and Instruction New
179839 Attachment B16. Pediatric Quality of Life (teen) (Parent) Form and Instruction New
179838 Attachment B15. Pediatric Quality of Life (child) (Parent) Form and Instruction New
179837 Attachment B14. Pediatric Quality of Life (young child) (Parent) Form and Instruction New
179836 Attachment B13. Parents' Questionnaire (Mental Health History) (Parent) Form and Instruction New
179835 Attachment B12. Parent-Child Relationship Inventory (Parent) Form and Instruction New
179834 Attachment B11. Health Risk Behavior Survey (high school) (Parent) Form and Instruction New
179833 Attachment B10. Health Risk Behavior Survey (middle school) (Parent) Form and Instruction New
179832 Attachment B9. Health Risk Behavior Survey (elementary) (Parent) Form and Instruction New
179831 Attachment B8. Demographic Survey (Parent) Form and Instruction New
179830 Attachment B7. Critical School Events (high school) (Parent) Form and Instruction New
179829 Attachment B6. Critical School Events (elementary, middle) (Parent) Form and Instruction New
179828 Attachment B5. Brief Impairment Scale (Parent) Form and Instruction New
179827 Attachment B4b. ADHD Treatment Quarterly Update (Parent) Form and Instruction New
179826 Attachment B4a. ADHD Treatment, Cost, and Client Satisfaction Questionnaire (Parent) Form and Instruction New
179825 Attachment B3. ADHD Communication and Knowledge Scan (Parent) Form and Instruction New
ICR Details
0920-0747 200704-0920-003
Historical Active
HHS/CDC
Longitudinal follow-up of Youth with Attention-Deficit/Hyperactivity Disorder identified in Community Settings: Examining Health Status, Correlates, and Effects associated with treatment for ADHD
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 07/25/2007
Retrieve Notice of Action (NOA) 04/25/2007
Approved consistent with revised materials submitted to OMB.
  Inventory as of this Action Requested Previously Approved
07/31/2010 36 Months From Approved
29,943 0 0
3,993 0 0
0 0 0
Attention-Deficit/Hyperactivity Disorder, one of the most common neurobehavioral disorders of childhood, is characterized by inattention, impulsivity/hyperactivity or both, such that daily functioning is compromised in multiple settings (DSM-IV-TR, 2000 diagnostic criteria; APA, 2000). CDC estimates that roughly 2.5 million children were taking medications to treat ADHD in 2003, although substantial disparities exist in rates of both parent-reported diagnosis and treatment across US states (MMWR, 2005). ADHD often persists into adolescence and can affect behavior and functioning even in adults. However, little is known about the disorder's developmental trajectory from non-clinical samples of youth identified and treated for ADHD through usual community care. The initial Project to Learn about ADHD in Youth (PLAY) study (OMB application No. 0920-0584) involved school district-wide screening at two sites (Oklahoma and South Carolina). A community-based sample of children with probable ADHD based on the screening data and a random sample of remaining children participated in an in-depth interview to provide information on diagnosis, symptoms, and associated health risk. The participants who completed the baseline interview will now be invited to participate in this proposed longitudinal follow up study, the PLAY study follow-up. Specifically, the Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, has provided funding to the University of Oklahoma Health Sciences Center and University of South Carolina to study the long-term outcomes and health status of children with ADHD identified and treated in community settings through a systematic follow-up of the subjects who participated in the PLAY study. The PLAY study follow-up will allow the CDC to determine: 1) trajectory of ADHD symptoms, 2) rates and patterns of comorbid conditions among those with ADHD, 3) describe health risk behavior in ADHD youth, and 4) described current or previous receipt of and access to treatment for ADHD among school-age youth. This population-based longitudinal research study will also help CDC address the imminent public health concerns around ADHD diagnosis and treatment and better understand and promote the health status of youth with ADHD.
US Code: 42 USC 241 Name of Law: Section 301 of Public Health Service Act - Research and Investigations
   US Code: 42 USC 201 Name of Law: Children's Health Act of 2000
  
None
Not associated with rulemaking
  71 FR 28867 05/18/2006
72 FR 16789 04/05/2007
No
34
IC Title Form No. Form Name
Attachment B3. ADHD Communication and Knowledge Scan (Parent) None ADHD Attachment B3 Parent Communication and Knowledge
Attachment B4a. ADHD Treatment, Cost, and Client Satisfaction Questionnaire (Parent) None ADHD Treatment, Cost, and Client Satisfaction Questionnaire
Attachment B4b. ADHD Treatment Quarterly Update (Parent) None ADHD Treatment Quarterly Update Scan
Attachment B5. Brief Impairment Scale (Parent) None Brief Impairment Scale
Attachment B6. Critical School Events (elementary, middle) (Parent) None Critical School Events (elementary, middle)
Attachment B7. Critical School Events (high school) (Parent) None Critical School Events (high school) (Parent)
Attachment B8. Demographic Survey (Parent) None Demographic Survey
Attachment B9. Health Risk Behavior Survey (elementary) (Parent) None Health Risk Behavior Survey (elementary)
Attachment B10. Health Risk Behavior Survey (middle school) (Parent) None Health Risk Behavior Survey (middle school)
Attachment B11. Health Risk Behavior Survey (high school) (Parent) None Health Risk Behavior Survey (high school)
Attachment B12. Parent-Child Relationship Inventory (Parent) None Parent-Child Relationship Inventory
Attachment B13. Parents' Questionnaire (Mental Health History) (Parent) None Parents' Questionnaire (Mental Health History) (Parent)
Attachment B14. Pediatric Quality of Life (young child) (Parent) None Pediatric Quality of Life (young child) (Parent)
Attachment B21. Vanderbilt Parent Rating Scale (Parent) None Vanderbilt Parent Rating Scale
Attachment B22. Brief Sensation Seeking Scale (11+ years) (Child) None Brief Sensation Seeking Scale (+11 years) (Child)
Attachment B23. Health Risk Behavior Survey (elementary) (Child) None Health Risk Behavior Survey (elementary) (Child)
Attachment B24. Health Risk Behavior Survey (middle school) (Child) None Health Risk Behavior Survey (middle school)
Attachment B25. Health Risk Behavior Survey (high school) (Child) None Health Risk Behavior Survey (high school)
Attachment B26. MARSH Self Description Questionnaire (7-12 years) (Child) None MARSH Self Description Questionnaire (7-12 years) (Child)
Attachment B27. MARSH Self Description Questionnaire (13-15 years) (Child) None MARSH Self Description Questionnaire (13-15 years)
Attachment B28. MARSH Self Description Questionnaire (16+ years) (Child) None MARSH Self Description Questionnaire (16+ years) (Child)
Attachment B29. Pediatric Quality of Life (young child) (Child) None Pediatric Quality of Life (young child)
Attachment B15. Pediatric Quality of Life (child) (Parent) None Pediatric Quality of Life (child) (Parent)
Attachment B16. Pediatric Quality of Life (teen) (Parent) None Pediatric Quality of Life (teen)
Attachment B17. Quarterly Update Events and Demographics (Parent) None Quarterly Update Events and Demographics (Parent)
Attachment B18. Social Isolation/Support (Parent) None Social Isolation/Support
Attachment B19. Strengths and Difficulties Questionnaire (4-10) (Parent) None Strengths and Difficulties Questionnaire (4-10)
Attachment B20. Strengths and Difficulties Questionnaire (11-17) (Parent) None Strengths and Difficulties Questionnaire (11-17)
Attachment B30. Pediatric Quality of Life (child) (Child) None Pediatric Quality of Life (Child)
Attachment B31. Pediatric Quality of Life (teen) (Child) None Pediatric Quality of Life (teen)
Attachment B32. People In My Life (Child) None People In My Life
Attachment B33. People In My Life/Inventory of Parent and Peer Attachment None People In My Life/Inventory of Parent and Peer Attachment
Attachment B34. Youth Demographic Survey (16+ years) (Child) None Youth Demographic Survey (16+ years)
Attachment B35. Teachery Survery (Teacher) None Teacher Survey
  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 29,943 0 0 29,943 0 0
Annual Time Burden (Hours) 3,993 0 0 3,993 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new data collection.
$766,451
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
Uncollected
Uncollected
Saleda Perryman
  No
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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
04/25/2007