NCHS Questionnaire Design Research Laboratory

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Questionnaire Design Research Laboratory - Testing Smoking Cessation and Oral Health Questions	Form	New	Available
Form unnumbered Disability/Mobility Testing Instrument	Form	New	Available
Form No number Questionnaire Design Research Laboratory	Form	New	Available
QDRL OMB-10-day package Wash Group Disability-REV 0209.doc	Supplementary Document	Uploaded 2009-02-12	Available
QDRL OMB-10-day package Wash Group Disability REV 0209att 1.doc	Supplementary Document	Uploaded 2009-02-12	Available
QDRL-OMB-10-day Collection of Birth Certificate Data-letter-020109.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2009-02-04	Available
QDRL-OMB-10-day collection Attachment 2-020109.doc	Supplementary Document	Uploaded 2009-02-04	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
190015	Questionnaire Design Research Laboratory - Testing Smoking Cessation and Oral Health Questions	Form	New
189765	Disability/Mobility Testing Instrument	Form	New
189115	Discussion guide for focus groups	Instruction	New
188016	Questionnaire Design Research Laboratory	Form	New

ICR Details

OMB Control No: 0920-0222	ICR Reference No: 200902-0920-005
Status: Historical Active	Previous ICR Reference No: 200803-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: NCHS Questionnaire Design Research Laboratory
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/18/2009
	Date Received in OIRA: 02/10/2009
Terms of Clearance: Prior terms continue.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2010	02/28/2010	02/28/2010
Responses	850	0	850
Time Burden (Hours)	600	0	600
Cost Burden (Dollars)	0	0	0

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Abstract: This submission describes proposed activities of the NCHS Questionnaire Design Research Laboratory. This project will test and evaluate the quality of the States' revised Birth Certificates. Methods for data collection are focus groups and cognitive testing.

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Authorizing Statute(s): US Code: 42 USC 242k Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 25590	05/01/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 66784	11/16/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Disability/Mobility Testing Instrument	unnumbered	Disability testing form
Discussion guide for focus groups
Questionnaire Design Research Laboratory	No number	Birth Certificate Evaluation
Questionnaire Design Research Laboratory - Testing Smoking Cessation and Oral Health Questions	none	QDRL - Testing Smoking Cessation Products and Services

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ICR Summary of Burden

table that charts list of burden

	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	850	850	0	0	0	0
Annual Time Burden (Hours)	600	600	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $1,002,450

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 02/10/2009

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