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Questionnaire Design Research Lab: 5600 Case CAPI and ACASI NHIS Field Test
NCHS Questionnaire Design Research Laboratory
OMB: 0920-0222
IC ID: 202862
OMB.report
HHS/CDC
OMB 0920-0222
ICR 201205-0920-001
IC 202862
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:
2022-12-21 - Revision of a currently approved collection
2021-08-16 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Questionnaire Design Research Lab: 5600 Case CAPI and ACASI NHIS Field Test
Form and Instruction
Proposed ACASI Questions
QDRL NHIS 5600 Attach 1- 05172012.docx
Form and Instruction
HIS-100C, January 2011 Manual for NHIS Field Reps Explan
QDRL NHIS 5600 Attach 2 - 0213 2012.docx
Form and Instruction
QDRL NHIS A-CASI 5600 letter to Dr. Schwab 06202012-final.docx
QDRL NHIS A-CASI 5600 letter to Dr
IC Document
QDRL NHIS 5600- Attach 4-2011 Core Qnne 0619 2012.docx
QDRL NHIS 5600- Attach 4-2011 Core Qnne 0619 2012
IC Document
QDRL NHIS 5600 Attach 3 -ltr--Dr. Sondik 0523 2012.LZ.doc
QDRL NHIS 5600 Attach 3 -ltr--Dr
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Questionnaire Design Research Lab: 5600 Case CAPI and ACASI NHIS Field Test
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
Proposed ACASI Questions
QDRL NHIS 5600 Attach 1- 05172012.docx
Yes
Yes
Fillable Fileable
Form and Instruction
none
HIS-100C, January 2011 Manual for NHIS Field Reps Explaning the Survey
QDRL NHIS 5600 Attach 2 - 0213 2012.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Immunization Management
Privacy Act System of Records
Title:
09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U. S. Population
FR Citation:
49 FR 37693
Number of Respondents:
5,600
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
5,600
0
0
0
0
0
Annual IC Time Burden (Hours)
5,600
0
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
QDRL NHIS A-CASI 5600 letter to Dr
QDRL NHIS A-CASI 5600 letter to Dr. Schwab 06202012-final.docx
06/25/2012
QDRL NHIS 5600- Attach 4-2011 Core Qnne 0619 2012
QDRL NHIS 5600- Attach 4-2011 Core Qnne 0619 2012.docx
06/25/2012
QDRL NHIS 5600 Attach 3 -ltr--Dr
QDRL NHIS 5600 Attach 3 -ltr--Dr. Sondik 0523 2012.LZ.doc
06/25/2012
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.