Information Collection

#6, #7, and #8 Bundled Sub-studies for HINTS, MDC and NExT

IC 195663 under ICR 201008-0925-003 · OMB 0925-0589.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0589 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 #6, #7, and #8 Bundled Sub-studies for HINTS, MDC and NExT	Form and Instruction
2 #7_Attach 7A 7C and 7E_MDC Cog Interview #7_Attach 7A 7C and 7E_MDC Cog Interview.docx	Form and Instruction
3 #8_Attach 8A, 8E, 8F, & 8G_Email, Guide & Qx_NExT #8_Attach 8A, 8E, 8F, & 8G_Email, Guide & Qx_NExT.doc	Form and Instruction
1 #6_Attach 6A & 6D Screen and Guide #6_Attach 6A & 6D Screen and Guide.pdf	Form and Instruction
1 #6_REV_Attach 6A 6D Screen and Guide #6_REV_Attach 6A 6D Screen and Guide.docx	Form and Instruction
1 #6_REV_Justif Memo and Attach 6B 6C 6E 6F 6G_HINTS #6_REV_Justif Memo and Attach 6B 6C 6E 6F 6G_HINTS.pdf	Form and Instruction
2 #7_REV_Justif Memo Attach 7B 7D and 7F_MDC #7_REV_Justif Memo Attach 7B 7D and 7F_MDC.docx	Form and Instruction
#6 #7 & #8_Bundled Gen IC_HINTS, MDC, NExT.doc Bundled Generic IC Forms	IC Document
#8_Justif Memo, Attach 8B, 8C, 8D, 8H_NExT.doc #8_Justif Memo, Attach 8B, 8C, 8D, 8H_NExT	IC Document
#7_Justif Memo, Attach 7B 7D and 7F_MDC.docx #7_Justif Memo, Attach 7B 7D and 7F_MDC	IC Document
Memo_Key To Bundled Pkg_0925-0589-6,7,8.doc Memo_Key To Bundled Pkg_0925-0589-6,7,8	IC Document
#6_Justif Memo and Attach 6B 6C 6E_6F_HINTS_rev.pdf #6_Justif Memo and Attach 6B 6C 6E_6F_HINTS	IC Document

IC Title:

#6, #7, and #8 Bundled Sub-studies for HINTS, MDC and NExT

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3	#8_Attach 8A, 8E, 8F, & 8G_Email, Guide & Qx_NExT	#8_Attach 8A, 8E, 8F, & 8G_Email, Guide & Qx_NExT.doc	Yes	Yes	Fillable Fileable
Form and Instruction	1	#6_Attach 6A & 6D Screen and Guide	#6_Attach 6A & 6D Screen and Guide.pdf	Yes	No	Printable Only
Form and Instruction	2	#7_REV_Justif Memo Attach 7B 7D and 7F_MDC	#7_REV_Justif Memo Attach 7B 7D and 7F_MDC.docx	Yes	No	Printable Only
Form and Instruction	1	#6_REV_Attach 6A 6D Screen and Guide	#6_REV_Attach 6A 6D Screen and Guide.docx	Yes	No	Printable Only
Form and Instruction	1	#6_REV_Justif Memo and Attach 6B 6C 6E 6F 6G_HINTS	#6_REV_Justif Memo and Attach 6B 6C 6E 6F 6G_HINTS.pdf	Yes	No	Printable Only
Form and Instruction	2	#7_Attach 7A 7C and 7E_MDC Cog Interview	#7_Attach 7A 7C and 7E_MDC Cog Interview.docx	Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: "Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD"

FR Citation: 67 FR 60743

Number of Respondents: 264

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 41 %

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	264	0	0	0	0	0
Annual IC Time Burden (Hours)	129	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
Bundled Generic IC Forms	#6 #7 & #8_Bundled Gen IC_HINTS, MDC, NExT.doc	11/30/2010
#8_Justif Memo, Attach 8B, 8C, 8D, 8H_NExT	#8_Justif Memo, Attach 8B, 8C, 8D, 8H_NExT.doc	11/30/2010
#7_Justif Memo, Attach 7B 7D and 7F_MDC	#7_Justif Memo, Attach 7B 7D and 7F_MDC.docx	11/30/2010
Memo_Key To Bundled Pkg_0925-0589-6,7,8	Memo_Key To Bundled Pkg_0925-0589-6,7,8.doc	12/02/2010
#6_Justif Memo and Attach 6B 6C 6E_6F_HINTS	#6_Justif Memo and Attach 6B 6C 6E_6F_HINTS_rev.pdf	12/02/2010

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