Testing of questions on cognitive functioning and other questions for the National Health Interview Survey (NHIS)

NCHS Questionnaire Design Research Laboratory

OMB: 0920-0222

IC ID: 220340

Information Collection (IC) Details

View Information Collection (IC)

Testing of questions on cognitive functioning and other questions for the National Health Interview Survey (NHIS) 16SS
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA NHIS Cognitive Functioning and other questions to be cognitively tested HIS Cog Func Att 1 Qnne 022416.docx NA Yes Yes Fillable Fileable
Form and Instruction NA Telephone Screening Script HIS Cog Func Att 3 Screener.docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

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

112 0
   
Individuals or Households
 
   100 %

  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 112 0 112 0 0 0
Annual IC Time Burden (Hours) 46 0 46 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Informed Consent HIS Cog Func Att 4 consent.docx 03/01/2016
Special Consent for Expanded Use of Video and Audio Recordings HIS Cog Func Att 5 Spec Con.docx 03/01/2016
Advertisement - Study Participants HIS Cog Func Att 2 Ad&flyer.docx 03/01/2016
Request - Questionnaire Design and Evaluation Researchcognitive functioning and other questions for (NHIS) HIS Cog Dis 10-day letter 022916.docx 03/01/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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