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ACASI field interviews for NHIS
NCHS Questionnaire Design Research Laboratory
OMB: 0920-0222
IC ID: 199758
OMB.report
HHS/CDC
OMB 0920-0222
ICR 201002-0920-006
IC 199758
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:
2022-12-21 - Revision of a currently approved collection
2021-08-16 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
ACASI field interviews for NHIS
Form and Instruction
ACASI field interviews
Attach 1 ACASI Qs-final.docx
Form and Instruction
Attach 2- CAPI & ACASI Observation Form-final.doc
Field test observation form
IC Document
Attach 3 Advance Letter-final.pdf
Advance letter
IC Document
QDRL NHIS A-CASI 50 letter-final.doc
Letter to Dr. Schwab
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
ACASI field interviews for NHIS
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
none
ACASI field interviews
Attach 1 ACASI Qs-final.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
50
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
50
0
0
0
0
0
Annual IC Time Burden (Hours)
55
0
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Field test observation form
Attach 2- CAPI & ACASI Observation Form-final.doc
10/12/2011
Advance letter
Attach 3 Advance Letter-final.pdf
10/12/2011
Letter to Dr. Schwab
QDRL NHIS A-CASI 50 letter-final.doc
10/12/2011
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.