Information Collection

NCHS Questionnaire Design Research Laboratory

IC 180128 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
QDRL-OMB-NHIS-CancerScreening-042507.doc Instruction
QDRL Letter.doc QDRL Letter IC Document
Attachment 1 Advertisment.doc Attachment 1 Advertisment IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NCHS Questionnaire Design Research Laboratory	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			QDRL-OMB-NHIS-CancerScreening-042507.doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 30 %

	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	20	0	0	0	0	0
Annual IC Time Burden (Hours)	20	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
QDRL Letter	QDRL Letter.doc	05/11/2007
Attachment 1 Advertisment	Attachment 1 Advertisment.doc	05/11/2007

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