National Survey of Children's Health Pretest

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Part B - NSCH 2015 Prestest revised 052015.docx	Supporting Statement B	Uploaded 2015-05-20	Available
Part A - NSCH 2015 Prestest revised 042815.docx	Supporting Statement A	Uploaded 2015-04-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
216350	National Survey of Children's Health Pretest	Instruction	New

ICR Details

OMB Control No: 0607-0984	ICR Reference No: 201504-0607-011
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOC/CENSUS	Agency Tracking No:
Title: National Survey of Children's Health Pretest
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/31/2015
	Date Received in OIRA: 04/30/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	36 Months From Approved
Responses	16,000	0	0
Time Burden (Hours)	2,262	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This submission requests approval for a small-scale (N=16,000 addresses) national pretest prior to fielding the first year production NSCH. This pretest will be planned and conducted to assess survey methodology, evaluate the survey instrument, and test operational procedures and processes. The pretest sample will consist of several panels to assess data collection mode preferences (Mail or Web) of respondents and amount of respondent incentives needed to gain participation in the study.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 3215	01/22/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 23769	04/29/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
National Survey of Children's Health Pretest

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ICR Summary of Burden

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	16,000	0	0	16,000	0	0
Annual Time Burden (Hours)	2,262	0	0	2,262	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection.

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Annual Cost to Federal Government: $2,776,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/30/2015

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