Cognitive Testing of Adults with Chronic Health Care Needs

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⚠️ Notice: This information collection may be referencing outdated material.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
Cognitive Testing of Adults with Chronic Health Care Needs Form and Instruction
Adults with Chronic Health Care Needs 0920-0222 QDRL ACHCN Attach 1 Resp Screener Instrument 072414.docx Form and Instruction
0920-0222 QDRL ACHCN letter072914.docx Letter to Dr. Schwab IC Document
0920-0222 QDRL ACHCN Attach2abc Adv.docx Advertisements IC Document

Information Collection (IC) Details

IC Title:	Cognitive Testing of Adults with Chronic Health Care Needs	Agency IC Tracking Number:	14ARU

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	Adults with Chronic Health Care Needs	0920-0222 QDRL ACHCN Attach 1 Resp Screener Instrument 072414.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Health and Demographic Surveys Conducted in Probability Samples of the US Population	FR Citation: 49 FR 37693

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Letter to Dr. Schwab	0920-0222 QDRL ACHCN letter072914.docx	08/06/2014
Advertisements	0920-0222 QDRL ACHCN Attach2abc Adv.docx	08/06/2014

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