Information Collection

QDRL - Spanish version of ACASI testing for sexual identity questions

IC 197794 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⚠️ Notice: This information collection may be referencing outdated material.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 - Spanish version of ACASI testing for sexual identity questions	Form
Spanish version - ACASI testing of sexual identity quest Spanish A-CASI Attach 2 instru.docx	Form
Spanish A-CASI Attach 1-Intro materials.docx Introduction to Interview and Interview Guide	IC Document
Spanish A-CASI Attach 3 flyers.docx Study flyers	IC Document
QDRL OMB-10-day letter Spanish A-CASI 0513 2011(rev. 0518).doc Letter to Dr. Schwab - justification	IC Document

IC Title:

QDRL - Spanish version of ACASI testing for sexual identity questions

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	Spanish version - ACASI testing of sexual identity questions	Spanish A-CASI Attach 2 instru.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 Probability 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: 100 %

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
Introduction to Interview and Interview Guide	Spanish A-CASI Attach 1-Intro materials.docx	05/18/2011
Study flyers	Spanish A-CASI Attach 3 flyers.docx	05/18/2011
Letter to Dr. Schwab - justification	QDRL OMB-10-day letter Spanish A-CASI 0513 2011(rev. 0518).doc	05/18/2011

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