Information Collection

NCHS Questionnaire Design Research Laboratory

IC 180013 under ICR 200612-0920-007 · OMB 0920-0222.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attach2-updated042007.doc	Instruction
Attachment 1a focus group advert.doc Attachment 1a focus group advert	IC Document
Attachment 1b One on One Cognitive int.doc Attachment 1b One on One Cognitive int	IC Document
Attachment 3a Protocol discussion guide.doc Attachment 3a Protocol discussion guide	IC Document
Attachment 3b Protocol for one on one intv.doc Attachment 3b Protocol for one on one intv	IC Document

IC Title:

NCHS Questionnaire Design Research Laboratory

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attach2-updated042007.doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 112

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	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	112	0	0	0	0	0
Annual IC Time Burden (Hours)	128	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 1a focus group advert	Attachment 1a focus group advert.doc	04/20/2007
Attachment 1b One on One Cognitive int	Attachment 1b One on One Cognitive int.doc	05/03/2007
Attachment 3a Protocol discussion guide	Attachment 3a Protocol discussion guide.doc	05/03/2007
Attachment 3b Protocol for one on one intv	Attachment 3b Protocol for one on one intv.doc	05/03/2007

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