2017 NHANES Health Behaviors Cognitive Interviewing Study

NCHS Questionnaire Design Research Laboratory

OMB: 0920-0222

IC ID: 221510

Information Collection (IC) Details

View Information Collection (IC)

2017 NHANES Health Behaviors Cognitive Interviewing Study 16AJD
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Attach 1ab Questionnaire 042716.docx Yes Yes Fillable Fileable
Other-WORD Attach 4ab telephone screener.docx No   Paper Only

Health Public Health Monitoring

 

126 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 126 0 126 0 0 0
Annual IC Time Burden (Hours) 38 0 38 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att2_Questionnaire - Spanish Version Attach 2ab Hand Card #ALQ1 Eng_Span.pdf 05/13/2016
Att 3a-d_Flyer (English /Spanish) Attach 3a-d Adv&Flyer.docx 05/13/2016
Att 5a-b_Consent Form Attach 5ab informed consent.docx 05/13/2016
Att 6a-b_Respondent Data Collection Sheet (Sample) Attach 6ab Resp Data Collection Sheet.docx 05/13/2016
Att 7a-b_Thank You Letters (English/Spanish) Attach 7ab Thank You letter.docx 05/13/2016
Att 8a-b_Special Consent Attach 8ab Special Consent.docx 05/13/2016
Request for Approval 10-day NHANES letter 051016.docx 05/13/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy