Rands

NCHS Questionnaire Design Research Laboratory

OMB: 0920-0222

IC ID: 218109

Information Collection (IC) Details

View Information Collection (IC)

RANDS 15BFA
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Telephone Screener Appendix 3ab - Telephone Screeners-final.docx Yes Yes Fillable Fileable
Form none Interview Questionnaire Appendix 1 - Interviewer Administered Questionnaire rev.docx No   Paper Only
Form none Web Intro Screen Appendix 6 - Web Introduction Screen.docx Yes Yes Fillable Fileable
Form none Respondent Demographic Data Demographic Info.doc No   Paper Only

Health Public Health Monitoring

09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population  49 FR 37693

4,132 0
   
Individuals or Households
 
   60 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,132 0 4,132 0 0 0
Annual IC Time Burden (Hours) 1,399 0 1,399 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Gallup Data Protection Appendix 7 - Gallup Data Protection and Security Overview 2015.pdf 09/08/2015
Informed Consent Appendix 4 - Informed Consent-final.docx 09/08/2015
Ad/Flyier Appendix 2 - Cog Int Adv&flyer.docx 09/08/2015
Supporting Statement OMB 10 Day Letter_RAND_0826 2015.docx 09/08/2015
Special Consent Appendix 5 - Special Consent rev2.docx 09/18/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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