Information Collection Request

NCHS Questionnaire Design Research Laboratory

ICR 201506-0920-003 · OMB 0920-0222 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-0222 CQDER - Opioid Plus Card Sort Form and Instruction New Available
Cognitive Interviewing Study of Opioid-Related Questions (Spanish Version) Form and Instruction New Available
Form 0920-0222 Collaborating Center for Questionnaire Design and Evaluation Research (CCQDER) Form and Instruction New Available
Cognitive Interviewing Study of Opioid-Related Questions Form and Instruction New Available
Questionnaire Design and Evaluation Research on Injury for the National Health Interview Survey (NHIS) Form and Instruction New Available
Cognitive Testing of Questions on Teen Alcohol and Marijuana Use Form and Instruction New Available
Form 092017AUC Cognitive Testing of NHIS health care utilization smoking, and selected child questions Form and Instruction New Available
Form 0920-0222 Cognitive Testing of Impaired Driving Questions for CDC National Center for Injury Prevention and Control (NPIPC) Form and Instruction New Available
Cognitive Testing of Middle Eastern North African (MENA) Questions Form New Available
Spanish Cognitive Study to Examine Traumatic Brain Injury Questions Form New Available
Trust, Acceptance and Confidence in Vaccines and Vaccination Schedules Form and Instruction New Available
Evaluation of Traumatic Brain Injury Questions for CDC's National Center for Injury Prevention and Control (NCIPC) Form and Instruction New Available
2016 CDC Healthcare Systems Scorecard (HSSC) Assessment Tool for Primary Care Practices Form New Available
Testing of questions on cognitive functioning and other questions for the National Health Interview Survey (NHIS) Form and Instruction New Available
PRAMS - English Form New Available
Form 0920-0222 2017 NHANES Health Behaviors Cognitive Interviewing Study/Spanish Form and Instruction New Repair queued
PRAMS Phase 8 - Spanish Form New Available
Form 0920-0222 (16AG) 2017 NHANES Health Behaviors Cognitive Interviewing Study Form and Instruction New Available
RANDS Form New Available
Att O Explain cog interview.doc Supplementary Document Uploaded 2015-06-11 Available
Att N Resp data collect sheet.doc Supplementary Document Uploaded 2015-06-11 Repair queued
Att M Sample advance letter.doc Supplementary Document Uploaded 2015-06-11 Available
Att L QDRL Voice mail script.doc Supplementary Document Uploaded 2015-06-11 Available
Att K Sample newspaper adv.doc Supplementary Document Uploaded 2015-06-11 Repair queued
Att J Sample flyer.doc Supplementary Document Uploaded 2015-06-11 Repair queued
Att I IRB approval.rtf Supplementary Document Uploaded 2015-06-11 Available
Att H Spec consent for fg.docx Supplementary Document Uploaded 2015-06-11 Available
Att G Spec consent 4offsite research.doc Supplementary Document Uploaded 2015-06-11 Available
Supp Statement A 060815.docx Supporting Statement A Uploaded 2015-06-11 Available
Att F Spec consent.docx Supplementary Document Uploaded 2015-06-11 Available
Att E informed consent.doc Supplementary Document Uploaded 2015-06-11 Available
Att D screening script.doc Supplementary Document Uploaded 2015-06-11 Available
Att C nondisclosure affidavit.doc Supplementary Document Uploaded 2015-06-11 Available
Attach B 60day Fed Reg Notice.pdf Supplementary Document Uploaded 2015-06-11 Available
Att A Pub Health Serv Act.doc Supplementary Document Uploaded 2015-06-11 Available
Supp Statement B 052815.doc Supporting Statement B Uploaded 2015-06-11 Available
IC Document Collections
IC IDCollectionTypeStatusForm
231689 CQDER - Opioid Plus Card Sort Form and Instruction New
231500 Cognitive Interviewing Study of Opioid-Related Questions (Spanish Version) Form and Instruction New
231481 Collaborating Center for Questionnaire Design and Evaluation Research (CCQDER) Form and Instruction New
231306 Cognitive Interviewing Study of Opioid-Related Questions Form and Instruction New
230189 NHANES Contact and Message Testing Other-ord New
229901 Research and Development Survey (RANDS) Cognitive Interviewing Sub-Study Other-WORD New
229527 Cognitive Testing of ASPE Criminal Justice System Questions Other-WORD New
229163 Cognitve Testing of Food for Babies and Mothers' Health Question on the NHANES B24 Month Questionnaire Other-WORD New
228813 Questionnaire Design and Evaluation Research on Injury for the National Health Interview Survey (NHIS) Form and Instruction New
228398 Cognitive Testing of National Survey of Hospital-Based Victim Services (NSHVS) Other-Telephone script New
228379 Cognitive Testing of Questions on Teen Alcohol and Marijuana Use Form and Instruction New
227302 Cognitive Testing of NHIS health care utilization smoking, and selected child questions Form and Instruction New
226479 Cognitive Testing of Impaired Driving Questions for CDC National Center for Injury Prevention and Control (NPIPC) Form and Instruction New
224421 Cognitive Testing of Middle Eastern North African (MENA) Questions Form New
223727 Cognitive testing of Confidentiality Pledge, Round 2 Other-WORD New
223623 Labor Force Module of Persons with Disabilities Round 2 Other-WORD New
223018 Spanish Cognitive Study to Examine Traumatic Brain Injury Questions Form New
222327 Trust, Acceptance and Confidence in Vaccines and Vaccination Schedules Form and Instruction New
221825 Congitive Testing of Confidentiality Pledges Other-Testing Materials New
221813 Evaluation of Traumatic Brain Injury Questions for CDC's National Center for Injury Prevention and Control (NCIPC) Form and Instruction New
221510 2017 NHANES Health Behaviors Cognitive Interviewing Study Other-WORD New
221257 Center for Questionnaire Design and Evaluation Research (CQDER) CMS 10-day Letter Instruction New
221137 2016 CDC Healthcare Systems Scorecard (HSSC) Assessment Tool for Primary Care Practices Form New
220340 Testing of questions on cognitive functioning and other questions for the National Health Interview Survey (NHIS) Form and Instruction New
220016 GenIC UNICEF/Washington Group School Environment Evaluation Study 2016 Other-WORD New
219197 PRAMS - English Form New
219178 Labor Force Module of Persons with Disabilities Other-Telephone Screener New
218756 2017 NHANES Health Behaviors Cognitive Interviewing Study/Spanish Form and Instruction New
218569 PRAMS Phase 8 - Spanish Form New
218517 2017 NHANES Health Behaviors Cognitive Interviewing Study Form and Instruction New
218109 RANDS Form New
ICR Details
0920-0222 201506-0920-003
Historical Active 201205-0920-001
HHS/CDC
NCHS Questionnaire Design Research Laboratory
Revision of a currently approved collection   No
Regular
Approved without change 07/21/2015
Retrieve Notice of Action (NOA) 06/19/2015
CDC will continue to submit individual collections under this generic clearance to OMB. OMB will strive to provide feedback on the individual collections within ten working days, whenever possible, as is currently the case. Standard remuneration of respondents for cognitive testing is $40.00. Higher remunerations may be requested with justification for difficult recruitments, focus groups, etc.
  Inventory as of this Action Requested Previously Approved
07/31/2018 36 Months From Approved 07/31/2015
24,000 0 9,300
13,150 0 9,450
0 0 0

The revision requested consists of an increase in burden hours for the next 3-year approval period. The purpose and use of collecting this information fall into five categories: 1) Development and testing of specific survey questionnaires; 2) Research on the cognitive and interpretive aspects of survey methodology; 3) Research on human-computer interfaces/usability; 4) Field tests/Pilot interviewing; and 5) Studies of the optimal design and presentation of statistical graphical and textual material. Methods for data collection include interviewer administered, self-administered, telephone, Computer Assisted Personal Interviewing (CAPI) and Computer Assisted Self-Interviewing (CASI), Audio Computer-Assisted Self-Interviewing (ACASI), and web-based questionnaires including: cognitive interviewing, focus groups, usability testing, and field tests/pilot household interviews.

US Code: 42 USC 242k Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  80 FR 13868 03/17/2015
80 FR 34644 06/17/2015
No

31
IC Title Form No. Form Name
2017 NHANES Health Behaviors Cognitive Interviewing Study 0920-0222 (16AG), 0920-0222 (16AG), 0920-0222 (16AG) , 0920-0222 (16AG), 0920-0222 (16AG) Appendix 3 - NHANES Screener 090215 ,   Appendix 1 - NHANES Questions for Cognitive Testing ,   Appendix 2a&b - NHANES Adv Flyer ,   Appendix 4 - NHANES Informed Consent ,   Appendix 5 - Special Consent
Cognitive Testing of NHIS health care utilization smoking, and selected child questions 092017AUC, 0920-17AUC Attach 3 Telephone Screener vcb 051017kw no confid pld update ,   Attach 3 Telephone Screener vcb 051017kw no confid pld update
Research and Development Survey (RANDS) Cognitive Interviewing Sub-Study
Center for Questionnaire Design and Evaluation Research (CQDER) CMS 10-day Letter 0920-16AEE, 0920-16AEE, 0920-16AEE CQDER CMS Att 3ab Telephone Screener ,   CQDER CMS Att 5ab Resp Data Collect ,   CQDER CMS Att 1ab Qnne wshowcards
Questionnaire Design and Evaluation Research on Injury for the National Health Interview Survey (NHIS) NA, NA Questionnaire - Injury Questions to Evaluate ,   Telephone Screener
Collaborating Center for Questionnaire Design and Evaluation Research (CCQDER) 0920-0222, 0920-0222, 0920-0222, 0920-0222 National Study of Long-Term Care Provider 2016 Adult Day Services Center Questionnaire ,   Adult Day Care Services Center (ADSC) Telephone Screening Script ,   Residential Care Community (RCC) Telephone Screening Script ,   National Study of Long-Term Care Providers 2016 Residential Care Community Questionnaire
Cognitive Testing of Impaired Driving Questions for CDC National Center for Injury Prevention and Control (NPIPC) 0920-0222, 0920-0222 Imp Driving - Attach 3 Screener rev-kw ,   Imp Driving - Attach 5 Resp Data Collection Sheet
Cognitive Interviewing Study of Opioid-Related Questions n/a, n/a, n/a Questionnaire for Cognitive Testing of Opioid Questions ,   Telephone Screener for Individuals Recruited through the Newspaper Ad ,   Respondent Data Collection Sheet (completed during the cognitive interview)
2017 NHANES Health Behaviors Cognitive Interviewing Study/Spanish 0920-0222, 0920-0222, 0920-0222, 0920-0222 Appendix 1 Questionnaire Spanish NHANES 100215 ,   Appendix 2a&b Ad&Flyer Spanish NHANES ,   Appendix 3 Telephone Screener Spanish NHANES 100215 ,   Appendix 5 Resp Data Collection Sheet Spanish NHANES
Labor Force Module of Persons with Disabilities
NHANES Contact and Message Testing
Cognitive Testing of National Survey of Hospital-Based Victim Services (NSHVS) none, none National Survey of Hospital-based Victim Services ,   Respondent Data Sheet
Testing of questions on cognitive functioning and other questions for the National Health Interview Survey (NHIS) NA, NA NHIS Cognitive Functioning and other questions to be cognitively tested ,   Telephone Screening Script
Cognitive Testing of ASPE Criminal Justice System Questions
Cognitive Interviewing Study of Opioid-Related Questions (Spanish Version) n/a, n/a, n/a Sample screening script for respondent contact Cognitive interviewing study of opioid use and pain questions ,   Spanish Questions to be cognitively tested ,   Spanish Respondent Data Collection Sheet
Labor Force Module of Persons with Disabilities Round 2 1 Questionnaire
Cognitive Testing of Middle Eastern North African (MENA) Questions None, None, None Questions to be cognitively tested ,   Telephone screening script ,   Respondent data collection sheet
Congitive Testing of Confidentiality Pledges none Respondent data collection sheet
Cognitive Testing of Questions on Teen Alcohol and Marijuana Use NA, NA Telephone Screening Script- Cognitive Testing of Questions on Teen Alcohol and Marijuana Use ,   Teen Alcohol and Marijuana Use Questions to be Cognitively Tested
Cognitve Testing of Food for Babies and Mothers' Health Question on the NHANES B24 Month Questionnaire
GenIC UNICEF/Washington Group School Environment Evaluation Study 2016
2017 NHANES Health Behaviors Cognitive Interviewing Study
Evaluation of Traumatic Brain Injury Questions for CDC's National Center for Injury Prevention and Control (NCIPC) NA, NA Questions to be Cognitively Tested ,   Telephone Screening Script for Adult/Self-Responder or Adult Proxy for Child 5-17
RANDS none, none, none, none Telephone Screener ,   Interview Questionnaire ,   Web Intro Screen ,   Respondent Demographic Data
PRAMS - English none, none PRAMS Phase 8 Supplemental Questions ,   PRAMS screener
Spanish Cognitive Study to Examine Traumatic Brain Injury Questions none, none, none Spanish Questions - TBI ,   Spanish Telephone Screener ,   Spanish Data Collection Sheet
Cognitive testing of Confidentiality Pledge, Round 2
PRAMS Phase 8 - Spanish none, none, none PRAMS Phase 8 - Spanish ,   Screener ,   Respondent Data Sheet
Trust, Acceptance and Confidence in Vaccines and Vaccination Schedules NA, NA, NA, NA Focus Group Screener ,   Cognitive Interview Screener ,   Focus Group Moderator Guide ,   Cognitive Interview Moderator Guide
2016 CDC Healthcare Systems Scorecard (HSSC) Assessment Tool for Primary Care Practices none, none, none Screener ,   Interview Questionnaire ,   Demographic Sheet
CQDER - Opioid Plus Card Sort 0920-0222, 0920-0222 Opioid Questionnaire - Card Sort ,   Telephone Screener

  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 24,000 9,300 0 14,700 0 0
Annual Time Burden (Hours) 13,150 9,450 0 3,700 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
CDC is requesting an increase in burden hours and respondents due to anticipated increase in the number and size of projects planned during the next 3 years.

$1,801,033
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Carol Marsh 404 639-4773 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
06/19/2015