Information Collection

Developmental Studies to Improve the National Health Care Surveys

IC 224408 under ICR 201407-0920-008 · OMB 0920-1030.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.