Cognitive Interviews for Prescription Drug Module Redesign

National Survey on Drug Use and Health: Methodological Field Tests

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0290 can be found here:

Documents and Forms

Document Name Document Type
Form Attachment F-Instr Cognitive Interviews for Prescription Drug Module Redesign Form and Instruction
Attachment F-Instr Instrument and Protocol Attachment F_RxDrugs_Cognitive Protocol_2010_Nov8.doc Form and Instruction
Attachment B Cognitive Recruitment Screener_2010_Oct.docm Attachment B-Recruitment Screener IC Document
Attachment C Cover Letter_2010_4_23.docm Attachment C-Cover Letter IC Document
PD OMB Memo.doc Transmittal Memo IC Document
Attachment G Cognitive Receipt for Participation_2010_4_23.docm Attachment G-Receipt for Participation IC Document
BTDB_PD_OMB_SS_final_12_16.doc Supporting Statement IC Document
Attachment_A_Cognitive_Recruitment_Flyers_12_16.doc Cognitive Recruitment Flyer IC Document
Attachment_D_-_Parental_Informed_Consent_Form_12_16.doc Parental Informed Consent Form IC Document
Attachment_E_Participant_Informed_Consent_12_16.doc Participant Informed Consent IC Document

Information Collection (IC) Details

IC Title:	Cognitive Interviews for Prescription Drug Module Redesign	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
Form and Instruction	Attachment F-Instrument and Protocol	Instrument and Protocol	Attachment F_RxDrugs_Cognitive Protocol_2010_Nov8.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 240	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	240	240
Annual IC Time Burden (Hours)	92	92
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment B-Recruitment Screener	Attachment B Cognitive Recruitment Screener_2010_Oct.docm	11/17/2010
Attachment C-Cover Letter	Attachment C Cover Letter_2010_4_23.docm	11/17/2010
Transmittal Memo	PD OMB Memo.doc	11/17/2010
Attachment G-Receipt for Participation	Attachment G Cognitive Receipt for Participation_2010_4_23.docm	11/17/2010
Supporting Statement	BTDB_PD_OMB_SS_final_12_16.doc	12/17/2010
Cognitive Recruitment Flyer	Attachment_A_Cognitive_Recruitment_Flyers_12_16.doc	12/17/2010
Parental Informed Consent Form	Attachment_D_-_Parental_Informed_Consent_Form_12_16.doc	12/17/2010
Participant Informed Consent	Attachment_E_Participant_Informed_Consent_12_16.doc	12/17/2010

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