4 Sets of Health Questions and Blood Donor History Questionnaire Evaluation

NCHS Questionnaire Design Research Laboratory

OMB: 0920-0222

IC ID: 203563

Information Collection (IC) Details

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4 Sets of Health Questions and Blood Donor History Questionnaire Evaluation
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction none Four Sets of Health Related Questions QDRL 4 sets of health related Qs - Attachment 1-0731 2012.docx Yes Yes Fillable Fileable
Form and Instruction none Blood Donor History Questionnaire QDRL OASH Blood Donor Attach 2-0731 2012.doc Yes Yes Fillable Fileable

Health Immunization Management

Health and Demographic Surveys Conducted in Probability Samples of the US Population  49 FR 37693

125 0
   
Individuals or Households
 
   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 125 0 0 0 0 0
Annual IC Time Burden (Hours) 125 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
genIC Combo Letter to Dr. Schwab QDRL OMB-10-day combo letter-0731 2012.doc 08/01/2012
4 Sets of Questions Flyer QDRL 4 sets Health Related Qs Attachment 2-0731 2012.docx 08/01/2012
Blood Donor Letter to Dr. Schwab QDRL OASH Blood Donor-10 day letter-0731 2012.doc 08/01/2012
Previous Blood Donor Letter to Dr. Schwab QDRL OASH Blood Donor-Attach 1-10 day letter from 1125 2011-v2.doc 08/01/2012
Blood Donor Flyers QDRL OASH Blood Donor Attach 3abc-0731 2012.doc 08/01/2012
QDRL 4 sets of questions letter QDRL 4 sets Health Related Qs 10-day letter-0827 2012.docx 08/27/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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