Evaluation of Traumatic Brain Injury Questions for CDC's National Center for Injury Prevention and Control (NCIPC)

NCHS Questionnaire Design Research Laboratory

OMB: 0920-0222

IC ID: 221813

Information Collection (IC) Details

View Information Collection (IC)

Evaluation of Traumatic Brain Injury Questions for CDC's National Center for Injury Prevention and Control (NCIPC) 16APT
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA Questions to be Cognitively Tested TBI Attach 1 Questionnaire 060216.docx NA No   Paper Only
Form and Instruction NA Telephone Screening Script for Adult/Self-Responder or Adult Proxy for Child 5-17 TBI Attach 3ab Screener 060316.docx NA No   Fillable Printable

Health Public Health Monitoring

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

112 0
   
Individuals or Households
 
   0 %

  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
GenIC Request - Cognitive Testing TBI 10-day letter 060216.docx 06/07/2016
Advertisement / Flyer TBI Attach 2a-e AdFlyers 060216.docx 06/07/2016
Informed Consent and Assent TBI Attach 4a-c Informed Consent&Assent.docx 06/07/2016
Adult Respondent Data Collection Sheet TBI Attach 5 Resp Data Collection Sheet.docx 06/07/2016
Thank You Letter TBI Attach 6 Thank You letter.docx 06/07/2016
Special Consent for Expanded Use of Video and Audio Recordings TBI Attach 7 Adult Special Consent.docx 06/07/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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