Cognitive Interviews for Questionnaire Redesign

National Survey on Drug Use and Health: Methodological Field Tests

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0290 can be found here:

Documents and Forms

Document Name Document Type
Form Protocol and Specs Cognitive Interviews for Questionnaire Redesign Form and Instruction
Protocol and Specs Protocol and Specs Attachment E - Protocol and Specs_revised.docx Form and Instruction
Attachment A - Cognitive Recruitment Flyers.doc Cognitive Recruitment Flyers IC Document
Attachment B - Recruitment Screening Scripts.docx Recruitment Screening Scripts IC Document
Attachment C - Participant Consent and Assent Forms.doc Participant Consent and Assent Forms IC Document
Attachment D - Parental Permission Form.docx Parental Permission Form IC Document
Attachment F - Cognitive Receipt for Participation.doc Cognitive Receipt for Participation IC Document
SubmitMemo.doc Transmittal Letter IC Document
OMB Supporting Statement_11.6.11.docx Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	Cognitive Interviews for Questionnaire Redesign	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	Protocol and Specs	Protocol and Specs	Attachment E - Protocol and Specs_revised.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

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 Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	66	66
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Cognitive Recruitment Flyers	Attachment A - Cognitive Recruitment Flyers.doc	10/05/2011
Recruitment Screening Scripts	Attachment B - Recruitment Screening Scripts.docx	10/05/2011
Participant Consent and Assent Forms	Attachment C - Participant Consent and Assent Forms.doc	10/05/2011
Parental Permission Form	Attachment D - Parental Permission Form.docx	10/05/2011
Cognitive Receipt for Participation	Attachment F - Cognitive Receipt for Participation.doc	10/05/2011
Transmittal Letter	SubmitMemo.doc	10/05/2011
Supporting Statement	OMB Supporting Statement_11.6.11.docx	10/06/2011

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