OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS)

ICR 201102-0920-008 · OMB 0920-0884 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 17 Short Strengths and Difficulties Questionnaire--Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS) - line 4 Form and Instruction New Available
Form 13 Child and Adolescent Psychiatric Assessment : Child Version Form and Instruction New Available
Form 8 Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS) - line 2 Child and Adolescent Psychiatric Assessment : Parent Version Form and Instruction New Available
Form 1 Pre-School Psychiatric Assessment Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS) - line 1 Form New Available
Attachment H Updated Advance Letters Informed Consent 4-6-2011 to OMB.docx Supplementary Document Uploaded 2011-04-06 Repair queued
Att A Applicable Laws.doc Supplementary Document Uploaded 2011-02-04 Repair queued
Att H Advance Letters Informed Consent.doc Supplementary Document Uploaded 2011-02-04 Repair queued
SS Part B.doc Supporting Statement B Uploaded 2011-02-04 Available
SS Part A.doc Supporting Statement A Uploaded 2011-02-04 Available
IC Document Collections
IC IDCollectionTypeStatusForm
196126 Short Strengths and Difficulties Questionnaire--Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS) - line 4 Form and Instruction New
196125 Child and Adolescent Psychiatric Assessment : Child Version Form and Instruction New
196124 Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS) - line 2 Child and Adolescent Psychiatric Assessment : Parent Version Form and Instruction New
196123 Pre-School Psychiatric Assessment Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS) - line 1 Form New
ICR Details
0920-0884 201102-0920-008
Historical Active
HHS/CDC
Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS)
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 04/06/2011
Retrieve Notice of Action (NOA) 02/04/2011
  Inventory as of this Action Requested Previously Approved
04/30/2013 24 Months From Approved
1,102 0 0
633 0 0
0 0 0
The Short Strengths and Difficulties Questionnaire is a five item mental health screening questionnaire designed to assess the mental health of children 4 years and older. The purpose of the proposed study is to calibrate the scores of this questionnaire against diagnostic psychiatric interviews to establish the cut-off score that best determines serious emotional disturbance.
US Code: 42 USC 242 Name of Law: National Center for Health Statistics
   US Code: 42 USC 290 Name of Law: Center for Mental Health Services
   US Code: 41 USC 306 Name of Law: National Center for Health Statistics
   PL: Pub.L. 111 - 5 115 Name of Law: American Recovery and Reinvestment Act of 2009
  
None
Not associated with rulemaking
  75 FR 29552 05/26/2010
75 FR 74053 11/30/2010
No
4
IC Title Form No. Form Name
Short Strengths and Difficulties Questionnaire--Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS) - line 4 17 Short Strengths and Difficulties Questionnaire
Pre-School Psychiatric Assessment Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS) - line 1 1, 2, 3, 4, 7, 6, 5 The Electronic Pre-School Psychiatric Assessment ,   Pre-School Psychiatric Assessment ,   Pre-School Psychiatric Assessment ,   Pre-School Psychiatric Assessment ,   Pre-School Psychiatric Assessment ,   Pre-School Psychiatric Assessment ,   Pre-School Psychiatric Assessment
Calibration of the Short Strengths and Difficulties Questionnaire (SDQ) in the National Health Interview Survey (NHIS) - line 2 Child and Adolescent Psychiatric Assessment : Parent Version 10, 8, 11, 12, 9 The Child and Adolescent Psychiatric Assessment (CAPA) ,   Child and Adolescent Psychiatric Assessment (Parent) ,   Child and Adolescent Psychiatric Assessment : Parent Version ,   Child and Adolescent Psychiatric Assessment : Parent Version ,   Child and Adolescent Psychiatric Assessment (parent)
Child and Adolescent Psychiatric Assessment : Child Version 14, 15, 16, 13 Child and Adolescent Psychiatric Assessment : Child Version ,   Child and Adolescent Psychiatric Assessment : Child Version ,   Child and Adolescent Psychiatric Assessment : Child Version ,   Child and Adolescent Psychiatric Assessment : Child Version
  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 1,102 0 0 1,102 0 0
Annual Time Burden (Hours) 633 0 0 633 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new ICR.
$736,149
Yes Part B of Supporting Statement
No
No
No
Yes
Uncollected
Petunia Gissendaner 4046390164
  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.
02/04/2011