Information Collection Request

NCHS Questionnaire Design Research Laboratory

ICR 201002-0920-006 · OMB 0920-0222 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Attachment 1 Evaluation of the Internet Version of the Respiratory Health of Healthcare Workers Questionnaire Form and Instruction New Available
QDRL - 2013 NHIS Form New Available
NHIS 575 ACASI Field Interviews Form and Instruction New Available
Respiratory Health of Healthcare Workers and Blood Donor History Questionnaires Form and Instruction New Repair queued
ACASI field interviews for NHIS Form and Instruction New Available
Asthma Management Supplement Form New Available
QDRL - Spanish version of ACASI testing for sexual identity questions Form New Available
QDRL - ACASI testing for sexual identity question on NHIS Form New Available
QDRL testing on NAMCS physician follow-up, NHIS Complementary and Alternative Medicine, and Spanish version of HIV behavioral surveillance Form New Repair queued
QDRL - questions for National HIV Behavioral Surveillance system and on gender Form New Available
QDRL - SLAITS National Survey of Children's Health Form New Available
NAMCS and NHAMCS Patient Record Evaluation Form New Repair queued
Measuring Trust in Official Statistics and Complementary and Alternative Medicine for NHIS Form New Available
Form No number Conducting Testing on NHIS and NHANES Questions Form New Available
NHIS Voice, Swallowing, Speech, Language and NHANES Creatine and Lifestyle Questions Form New Available
Questionnaire Design Research Laboratory - Disability Study Form New Available
QDRL-OMB Supporting Statement B- final 112709.doc Supporting Statement B Uploaded 2010-01-22 Available
QDRL-OMB Attachment O.doc Supplementary Document Uploaded 2010-01-22 Available
QDRL-OMB Attachment N.doc Supplementary Document Uploaded 2010-01-22 Available
QDRL-OMB Attachment M.doc Supplementary Document Uploaded 2010-01-22 Repair queued
QDRL-OMB Attachment L.doc Supplementary Document Uploaded 2010-01-22 Repair queued
QDRL-OMB Attachment K.doc Supplementary Document Uploaded 2010-01-22 Repair queued
QDRL-OMB Attachment J.doc Supplementary Document Uploaded 2010-01-22 Repair queued
QDRL-OMB Attachment I.doc Supplementary Document Uploaded 2010-01-22 Repair queued
QDRL-OMB Attachment H.doc Supplementary Document Uploaded 2010-01-22 Available
QDRL-OMB Attachment G.doc Supplementary Document Uploaded 2010-01-22 Available
QDRL-OMB Attachment F.doc Supplementary Document Uploaded 2010-01-22 Repair queued
QDRL-OMB Attachment E.doc Supplementary Document Uploaded 2010-01-22 Repair queued
QDRL-OMB Attachment D.doc Supplementary Document Uploaded 2010-01-22 Available
QDRL-OMB Attachment C.doc Supplementary Document Uploaded 2010-01-22 Repair queued
QDRL-OMB Attachment B.doc Supplementary Document Uploaded 2010-01-22 Repair queued
QDRL-OMB Attachment A.doc Supplementary Document Uploaded 2010-01-22 Available
QDRL-2010-12 Supporting Statement A - final final 021710.doc Supporting Statement A Uploaded 2010-02-17 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
201870 Evaluation of the Internet Version of the Respiratory Health of Healthcare Workers Questionnaire Form and Instruction New
201536 QDRL - 2013 NHIS Form New
200804 NHIS 575 ACASI Field Interviews Form and Instruction New
200032 Respiratory Health of Healthcare Workers and Blood Donor History Questionnaires Form and Instruction New
199758 ACASI field interviews for NHIS Form and Instruction New
199221 Testing Long Term Care Questions Other-Interview New
198749 Asthma Management Supplement Form New
197794 QDRL - Spanish version of ACASI testing for sexual identity questions Form New
197466 QDRL - ACASI testing for sexual identity question on NHIS Form New
196057 QDRL testing on NAMCS physician follow-up, NHIS Complementary and Alternative Medicine, and Spanish version of HIV behavioral surveillance Form New
195459 QDRL - questions for National HIV Behavioral Surveillance system and on gender Form New
195152 QDRL - SLAITS National Survey of Children's Health Form New
194864 NAMCS and NHAMCS Patient Record Evaluation Form New
193785 Measuring Trust in Official Statistics and Complementary and Alternative Medicine for NHIS Form New
193241 Conducting Testing on NHIS and NHANES Questions Form New
192888 QDRL - NCHS Website Usability Testing Instruction New
192790 NHIS Voice, Swallowing, Speech, Language and NHANES Creatine and Lifestyle Questions Form New
192246 Questionnaire Design Research Laboratory - Disability Study Form New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2013 36 Months From Approved 02/28/2010
850 0 850
1,800 0 600
0 0 0





Reginfo record details
18
table that charts list of burden
IC Title Form No. Form Name
QDRL - NCHS Website Usability Testing
Conducting Testing on NHIS and NHANES Questions No number Testing NHIS and NHANES Questions
QDRL - ACASI testing for sexual identity question on NHIS none Att 2 - Cognitive testing interview guide
ACASI field interviews for NHIS none ACASI field interviews
QDRL - 2013 NHIS none NHIS 2013 questions
NAMCS and NHAMCS Patient Record Evaluation none Patient Record Evaluation
QDRL - SLAITS National Survey of Children's Health none National Survey of Children's Health
Measuring Trust in Official Statistics and Complementary and Alternative Medicine for NHIS none, none Measuring Trust - questions ,   CAM - interview guide
QDRL testing on NAMCS physician follow-up, NHIS Complementary and Alternative Medicine, and Spanish version of HIV behavioral surveillance none, none, none, none, none NHBS - Spanish version for MSM ,   NHBS - Spanish screener ,   Physican Workflow EHR no Adoption Survey ,   Physican Workflow EHR some Adoption Survey ,   Child Component of CAMS
QDRL - Spanish version of ACASI testing for sexual identity questions none Spanish version - ACASI testing of sexual identity questions
Questionnaire Design Research Laboratory - Disability Study none QDRL - Disability Study
NHIS 575 ACASI Field Interviews none 575 ACASI Field Test
Evaluation of the Internet Version of the Respiratory Health of Healthcare Workers Questionnaire Attachment 1 Respiratory Health Internet Version
Testing Long Term Care Questions
Asthma Management Supplement none 2012 Asthma Supplement
NHIS Voice, Swallowing, Speech, Language and NHANES Creatine and Lifestyle Questions none NHIS Voice, Swallowing, Speech and Language
Respiratory Health of Healthcare Workers and Blood Donor History Questionnaires none, none Survey on Respiratory Health ,   Blood Donor History Questionnaire
QDRL - questions for National HIV Behavioral Surveillance system and on gender none, none NHBS questions for cognitive testing ,   NHBS screeners

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) 1,800 600 0 0 1,200 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No