Cognitive Interview Guide

Child Health Disparities Substudy for the National Children's Study (NCS)- Phase 1

Documents and Forms

Document Name Document Type
Form 2.1 Cognitive Interview Guide Form and Instruction
2.1 Survey Attach 6. Cognitive Interview Guide.docx Form and Instruction
Attach 4. Newest Vital Sign Food Label.pdf Attach 4. Newest Vital Sign Food Label IC Document
Attach 10. Note to File.docx Attach 10. Note to File IC Document

Information Collection (IC) Details

IC Title:	Cognitive Interview Guide	Agency IC Tracking Number:

Is this a Common Form? No		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	2.1	Survey	Attach 6. Cognitive Interview Guide.docx		Yes	Yes	Paper Only

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records
Title:	FR Citation:

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

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	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
Attach 4. Newest Vital Sign Food Label	Attach 4. Newest Vital Sign Food Label.pdf	02/14/2013
Attach 10. Note to File	Attach 10. Note to File.docx	02/14/2013

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