Information Collection Request

Health Information National Trends Survey 4 (HINTS 4) (NCI)

ICR 201107-0925-002 · OMB 0925-0538 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Cycle 1 Qx for Health Information National Trends Survey 4 (HINTS4) Form and Instruction Modified Available
Form 2 Cycle 2 Qx for Health Information National Trends Survey 4 (HINTS4) Form and Instruction New Available
Form 4 Cycle 4 Qx for Health Information National Trends Survey 4 (HINTS4) Form and Instruction Modified Available
Form 3 Cycle 3 Qx for Health Information National Trends Survey 4 (HINTS4) Form and Instruction Modified Available
FINAL PROTOCOL CHANGES_9-12-11-td.doc Supplementary Document Uploaded 2011-09-30 Available
Appendix M - FINAL Respondent selection pages_ 9-20-11.doc Supplementary Document Uploaded 2011-09-30 Available
Supporting Statement B_FINAL_9-20-11-2.doc Supporting Statement B Uploaded 2011-09-30 Available
Appendix M - Respondent Selection Variations.docx Supplementary Document Uploaded 2011-06-27 Available
Appendix J - Theoretical Framework.doc Supplementary Document Uploaded 2011-06-27 Available
Appendix I - OHSR Exempt and IRB Approvals.pdf Supplementary Document Uploaded 2011-06-27 Available
Appendix H - Westat Confidentiality Pledge.pdf Supplementary Document Uploaded 2011-06-27 Available
Appendix G - Sources Reviewed.doc Supplementary Document Uploaded 2011-06-27 Available
Appendix F2 - Privacy Act Memo.pdf Supplementary Document Uploaded 2011-06-27 Available
Appendix F1 - PIA.docx Supplementary Document Uploaded 2011-06-27 Available
Appendix E - HINTS Publications.docx Supplementary Document Uploaded 2011-06-27 Available
Appendix D - Health People 2020 Objectives.pdf Supplementary Document Uploaded 2011-06-27 Available
Appendix A - Evaluation Results.docx Supplementary Document Uploaded 2011-06-27 Available
Cover Memo.doc Supplementary Document Uploaded 2011-06-27 Available
Appendix K - Cover Letters in English.docx Supplementary Document Uploaded 2011-06-27 Available
Appendix L - Letters in Spanish.docx Supplementary Document Uploaded 2011-06-27 Available
Appendix L - Letters in Spanish.docx Supplementary Document Uploaded 2011-06-27 Available
Appendix K - Cover Letters in English.docx Supplementary Document Uploaded 2011-06-27 Repair queued
Appendix L - Letters in Spanish.docx Supplementary Document Uploaded 2011-06-27 Available
Appendix K - Cover Letters in English.docx Supplementary Document Uploaded 2011-06-27 Available
Appendix K - Cover Letters in English.docx Supplementary Document Uploaded 2011-06-27 Available
Appendix L - Letters in Spanish.docx Supplementary Document Uploaded 2011-06-27 Repair queued
Supporting Statement A_6-27-11.doc Supporting Statement A Uploaded 2011-06-27 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
7462 Cycle 1 Qx for Health Information National Trends Survey 4 (HINTS4) Form and Instruction Modified
198508 Cycle 2 Qx for Health Information National Trends Survey 4 (HINTS4) Form and Instruction New
181324 Cycle 4 Qx for Health Information National Trends Survey 4 (HINTS4) Form and Instruction Modified
181323 Cycle 3 Qx for Health Information National Trends Survey 4 (HINTS4) Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2014 36 Months From Approved
14,066 0 0
7,034 0 0
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 14,066 0 0 14,066 0 0
Annual Time Burden (Hours) 7,034 0 0 7,034 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No