Developmental Studies to Improve the National Health Care Surveys

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1030 can be found here:

Documents and Forms

Document Name Document Type
Developmental Studies to Improve the National Health Care Surveys Form and Instruction
Contact Information Verification Attachment B-Contact Information Verification.doc Form and Instruction
Telephone Scheduling Script Attachment D-Scheduling Script for Interviews.doc Form and Instruction
Telephone Interview - IDD Exploratory Work Attachment E - IDD Telephone Interview Protocol.docx Form and Instruction
Attach A-HSRD form and protocol_10-26-16.pdf Research Determination IC Document
Attachment C-Advance Package NCHS Cover Letter Email.doc Cover Letter IC Document
State agency interviews SSA 111016.doc Supporting Statement A IC Document
State agency interviews SSB 111016.doc Supporting Statement B IC Document
Attachment F-Thank You Letter for Interview.doc Thank You Letter IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Developmental Studies to Improve the National Health Care Surveys	Agency IC Tracking Number:	17EH

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Electronic Capability
Form and Instruction	NA	Contact Information Verification	Attachment B-Contact Information Verification.doc	NA	No	Paper Only
Form and Instruction	NA	Telephone Scheduling Script	Attachment D-Scheduling Script for Interviews.doc	NA	No	Paper Only
Form and Instruction	NA	Telephone Interview - IDD Exploratory Work	Attachment E - IDD Telephone Interview Protocol.docx	NA	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0167 - Health Resources Utilization Statistics	FR Citation: 49 FR 37697

Number of Respondents: 195	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	195	195
Annual IC Time Burden (Hours)	45	45
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Research Determination	Attach A-HSRD form and protocol_10-26-16.pdf	11/14/2016
Cover Letter	Attachment C-Advance Package NCHS Cover Letter Email.doc	11/14/2016
Supporting Statement A	State agency interviews SSA 111016.doc	11/15/2016
Supporting Statement B	State agency interviews SSB 111016.doc	11/15/2016
Thank You Letter	Attachment F-Thank You Letter for Interview.doc	11/16/2016

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