Information Collection

ACASI field interviews for NHIS

IC 199758 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⚠️ Notice: This information collection may be referencing outdated material.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
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

IC Title:

ACASI field interviews for 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 and Instruction	none	ACASI field interviews	Attach 1 ACASI Qs-final.docx		Yes	Yes	Fillable Fileable

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 %

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	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

table that charts IC Documents
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.