NHIS 575 ACASI Field Interviews

NCHS Questionnaire Design Research Laboratory

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:

Documents and Forms

Document Name Document Type
NHIS 575 ACASI Field Interviews Form and Instruction
575 ACASI Field Test QDRL NHIS 575 Attach 1.docx Form and Instruction
QDRL NHIS A-CASI 500 letter-sexIDQ-final 0110 2012.docx Letter to Dr. Schwab IC Document
QDRL NHIS 575 Attach 3.doc Att 3 - NHIS Advance letter IC Document
QDRL NHIS 575 Attach 2.docx Att 2 - Manual for Field Reps IC Document

Information Collection (IC) Details

IC Title:	NHIS 575 ACASI Field Interviews	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	575 ACASI Field Test	QDRL NHIS 575 Attach 1.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

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: 575	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	575	0	0	0	0	0
Annual IC Time Burden (Hours)	575	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Letter to Dr. Schwab	QDRL NHIS A-CASI 500 letter-sexIDQ-final 0110 2012.docx	01/11/2012
Att 3 - NHIS Advance letter	QDRL NHIS 575 Attach 3.doc	01/11/2012
Att 2 - Manual for Field Reps	QDRL NHIS 575 Attach 2.docx	01/11/2012

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