Information Collection

Questionnaire Design Research Lab: 5600 Case CAPI and ACASI NHIS Field Test

IC 202862 under ICR 201205-0920-001 · OMB 0920-0222.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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

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 %

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	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

table that charts IC Documents
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.