Information Collection

QDRL - ACASI testing for sexual identity question on NHIS

IC 197466 under ICR 201002-0920-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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
QDRL - ACASI testing for sexual identity question on NHIS	Form
Att 2 - Cognitive testing interview guide QDRL 10-day sex ID NHIS Attachment 2 ACASI instru-v2.docx	Form
QDRL OMB-10-day letter-A-CASI HR 041511.doc 10 day letter to Dr. Schwab	IC Document
QDRL 10-day sex ID NHIS Attachment 3 flyers.docx Att 3a - advertisement/flyer	IC Document
OMB QDRL 10-day sex ID NHUIS Attachment 1 Intro materials-v2.docx Att 1 - Instructions and introductory materials	IC Document

IC Title:

QDRL - ACASI testing for sexual identity question on NHIS

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
Form	none	Att 2 - Cognitive testing interview guide	QDRL 10-day sex ID NHIS Attachment 2 ACASI instru-v2.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: Health and Demographic Surveys Conducted in Probablity Samples of the US Population

FR Citation: 49 FR 37693

Number of Respondents: 100

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	100	0	0	0	0	0
Annual IC Time Burden (Hours)	150	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
10 day letter to Dr. Schwab	QDRL OMB-10-day letter-A-CASI HR 041511.doc	04/25/2011
Att 3a - advertisement/flyer	QDRL 10-day sex ID NHIS Attachment 3 flyers.docx	04/25/2011
Att 1 - Instructions and introductory materials	OMB QDRL 10-day sex ID NHUIS Attachment 1 Intro materials-v2.docx	04/25/2011

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