GENERIC IC Gen IC Questionnaire Design Research Lab - 2013 Comparative Disability Questions and Mode Effects Study

NCHS Questionnaire Design Research Laboratory

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
GENERIC IC Gen IC Questionnaire Design Research Lab - 2013 Comparative Disability Questions and Mode Effects Study Form
Attachment 1a: WHO Questionnaire QDRL Att 1a - CDME WHO Questionnaire.docx Form
Attachment 1b: Washington Group Questionnaire QDRL Att 1b_CDME Washington Grp Quest.docx Form
Attachments 3a & 3b--Telephone Screeners Att 3a, &b - CDME Tel Scrns 0711 2013.docx Form and Instruction
QDRL Att 2a, b, &c - CDME Ads.docx QDRL Att 2a, b, &c - CDME Ads IC Document
QDRL CDME 10-day letter-07242013.docx QDRL CDME 10-day letter-07242013 IC Document

Information Collection (IC) Details

IC Title:	GENERIC IC Gen IC Questionnaire Design Research Lab - 2013 Comparative Disability Questions and Mode Effects Study	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	None	Attachment 1a: WHO Questionnaire	QDRL Att 1a - CDME WHO Questionnaire.docx	Yes	Yes	Fillable Fileable
Form	None	Attachment 1b: Washington Group Questionnaire	QDRL Att 1b_CDME Washington Grp Quest.docx	Yes	Yes	Fillable Fileable
Form and Instruction	None	Attachments 3a & 3b--Telephone Screeners	Att 3a, &b - CDME Tel Scrns 0711 2013.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

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	120	0	0	0	0	0
Annual IC Time Burden (Hours)	180	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
QDRL Att 2a, b, &c - CDME Ads	QDRL Att 2a, b, &c - CDME Ads.docx	07/25/2013
QDRL CDME 10-day letter-07242013	QDRL CDME 10-day letter-07242013.docx	07/25/2013

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