Information Collection Request

Questionnaire Cognitive Interviewing and Pretesting (NCI)

ICR 201302-0925-007 · OMB 0925-0589 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Sub-study #10_Requirement Gathering for a Biobank Economic Modeling Tool (BEMT) Form and Instruction New Available
Form 1 Sub-study #9_Health Information National Trends Survey 4 (HINTS 4) Cog Test of Cycle 4 (Revised) Form and Instruction New Available
Form 1 Sub-study #7_Development of Consensus Measures of Distress for the Grid Enabled Measures-Distress Measurement (GEM-DM) Workspace Form and Instruction New Repair queued
Form 1 Sub-study #6_Resubmission of Health Information National Trends Survey 4 (HINTS 4) Cognitive Testing of HINTS-FDA Instrument Form and Instruction New Available
Form 1 Sub-study #7_Survey Instrument Designed to Assess Users' Perceptions of Website Changes Form and Instruction New Available
Form 3 Sub-study #5: Health Information National Trends Survey 4 (HINTS 4) Cognitive Testing of Cycle 3 Instrument Form and Instruction Modified Available
Form 2 Sub-study #4: Cognitive Testing of the Family Life, Activity, Sun, Health, and Eating (FLASHE) Survey Form and Instruction Modified Available
Form 2 Sub-study #3_Health Information National Trends Survey 4 (HINTS 4) Cognitive Testing of Cycle 2 Instrument Form and Instruction Modified Available
Form 1 Bundled Website Usability Testings #1 (ASA24) and #2 (GEM) Form and Instruction Modified Available
Change Request memo_0925-0589 GW.doc Justification for No Material/Nonsubstantive Change Uploaded 2013-02-22 Available
Attach G_IRB Approval.pdf Supplementary Document Uploaded 2013-02-27 Available
Attach F_Reminder Letter.docx Supplementary Document Uploaded 2013-02-27 Available
Attach D_Advertisements.docx Supplementary Document Uploaded 2013-02-27 Available
Attach C-2_Consent Form Spanish.docx Supplementary Document Uploaded 2013-02-27 Available
Attach A-2_Questionnaire to Test_Spanish.docx Supplementary Document Uploaded 2013-02-27 Available
Attach A-1_Questionnaire to Test_English.docx Supplementary Document Uploaded 2013-02-27 Available
Justif Memo 12-5-12.doc Supplementary Document Uploaded 2013-02-27 Available
Attach C-1_Consent Form English.docx Supplementary Document Uploaded 2013-02-27 Available
Attach 4E FLASHE Cognitive Testing Plan.docx Supplementary Document Uploaded 2013-02-27 Available
Attach 4D Reminder Letter-Email.docx Supplementary Document Uploaded 2013-02-27 Available
Justification Memo.doc Supplementary Document Uploaded 2013-02-27 Available
Generic Sub-Study Form.doc Supplementary Document Uploaded 2013-02-27 Available
Attach 4C Informed Consent Forms - Parent and Teen.docx Supplementary Document Uploaded 2013-02-27 Available
#3_Justif_MemoAttachments_C_D_F_G_HINTS_Cycle2_01-12-12.DOC Supplementary Document Uploaded 2013-02-27 Available
#2_Justifi Memo Attach 2A 2B_GEM_FINAL.docx Supplementary Document Uploaded 2013-02-27 Available
Gen IC Forms #1 and #2_ASA-24 & GEM Usability Testing.doc Supplementary Document Uploaded 2013-02-27 Available
Memo to OMB_Key To Bundled #1 and #2.doc Supplementary Document Uploaded 2013-02-27 Available
#1 Justif Memo Attach 1B 1D_5-18-2011.doc Supplementary Document Uploaded 2013-02-27 Available

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
04/30/2014 04/30/2014 04/30/2014
4,800 0 3,600
6,000 0 3,600
0 0 0





Reginfo record details
9
table that charts list of burden
IC Title Form No. Form Name
Sub-study #9_Health Information National Trends Survey 4 (HINTS 4) Cog Test of Cycle 4 (Revised) 2, 1, 3, 4, 5, 6 Screener - Revised - English ,   Screener - Revised - Spanish ,   Consent Form - English ,   Consent Form - Spanish ,   Interview Protocol - English ,   Interview Protocol - Spanish
Sub-study #4: Cognitive Testing of the Family Life, Activity, Sun, Health, and Eating (FLASHE) Survey 2, 3, 4, 1, 5, 6, 7 Parent Diet and Demographic Survey ,   Parent Physical Activity Survey and Checklist ,   Teen Diet and Demographic Survey ,   FLASHE Screener ,   Teen Physical Activity Survey and Recall ,   Parent Cognitive Interview Guide ,   Teen Cognitive Interview Guide
Sub-study #5: Health Information National Trends Survey 4 (HINTS 4) Cognitive Testing of Cycle 3 Instrument 3, 2, 4, 1 Interview Protocol (English) ,   Screener (Spanish) ,   Interview Protocol (Spanish) ,   Screener (English)
Sub-study #7_Survey Instrument Designed to Assess Users' Perceptions of Website Changes 1 ARP Website Survey
Sub-study #10_Requirement Gathering for a Biobank Economic Modeling Tool (BEMT) 1, 2 Survey Screenshots ,   Follow-Up-Debriefing
Bundled Website Usability Testings #1 (ASA24) and #2 (GEM) 1, 2 #1_ASA 24 Screener and Guide ,   #2_GEM Attach 2C 2D Survey and Guide
Sub-study #3_Health Information National Trends Survey 4 (HINTS 4) Cognitive Testing of Cycle 2 Instrument 2, 1, 3 HINTS Cycle 2 Cognitive Interview Protocol ,   HINTS Cycle 2 Questionnaire ,   HINTS Cycle 2 Screener
Sub-study #6_Resubmission of Health Information National Trends Survey 4 (HINTS 4) Cognitive Testing of HINTS-FDA Instrument 4, 3, 1, 2 English Screener ,   Spanish Screener ,   Spanish Cognitive Interview Script ,   English Cognitive Interview Script
Sub-study #7_Development of Consensus Measures of Distress for the Grid Enabled Measures-Distress Measurement (GEM-DM) Workspace 1 GEM-DM Survey

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 4,800 3,600 0 1,200 0 0
Annual Time Burden (Hours) 6,000 3,600 0 2,400 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No