Information Collection

Cognitve Testing of Food for Babies and Mothers' Health Question on the NHANES B24 Month Questionnaire

IC 229163 under ICR 201506-0920-003 · OMB 0920-0222.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:

Documents and Forms

Document Name Document Type
Attach 1a - Qnne (Eng) 112417.doc Other-WORD
Attach 1b - Qnne (Span) 112417.doc Other-WORD
Attach 4a - Telephone Screener (Eng).docx Other-WoRD
Attach 4b - Telephone Screener (Span) updated trans.docx Other-WORD
Attach 2a-d - Ads&Flyers (Eng & Span).docx Att 2a-d. English - Semi Targeted Advertisement IC Document
Attach 3 - Voice Mail Script (Eng only).docx Att 3. Sample Script of CCQDER Voice Mail IC Document
Attach 5ab - Informed Consent (Eng & Span).docx Att 5a-b. Informed Consent (English/Spanish) IC Document
Attach 6ab - Resp Data Collect (Eng & Span).docx Att 6a-b. Resp Data Collect IC Document
Attach 7ab - Thank You Letter (Eng & Span).docx Att 7a-b. Thank You Letter (English & Spanish) IC Document
Attach 8ab - Special Consent (Eng & Span).docx Att 8 a-b. Special Consent (English and Spanish) IC Document
10-day letter NHANES B24 112417.docx 10 day Letter NHANES B24 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Cognitve Testing of Food for Babies and Mothers' Health Question on the NHANES B24 Month Questionnaire	Agency IC Tracking Number:	0920-0222 18GQ

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-WORD	Attach 1a - Qnne (Eng) 112417.doc	No	Fillable Fileable
Other-WORD	Attach 1b - Qnne (Span) 112417.doc	No	Fillable Fileable
Other-WoRD	Attach 4a - Telephone Screener (Eng).docx	No	Fillable Fileable
Other-WORD	Attach 4b - Telephone Screener (Span) updated trans.docx	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the US Population	FR Citation: 49 FR 37693

Number of Respondents: 185	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	185	185
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 2a-d. English - Semi Targeted Advertisement	Attach 2a-d - Ads&Flyers (Eng & Span).docx	11/28/2017
Att 3. Sample Script of CCQDER Voice Mail	Attach 3 - Voice Mail Script (Eng only).docx	11/28/2017
Att 5a-b. Informed Consent (English/Spanish)	Attach 5ab - Informed Consent (Eng & Span).docx	11/28/2017
Att 6a-b. Resp Data Collect	Attach 6ab - Resp Data Collect (Eng & Span).docx	11/28/2017
Att 7a-b. Thank You Letter (English & Spanish)	Attach 7ab - Thank You Letter (Eng & Span).docx	11/28/2017
Att 8 a-b. Special Consent (English and Spanish)	Attach 8ab - Special Consent (Eng & Span).docx	11/28/2017
10 day Letter NHANES B24	10-day letter NHANES B24 112417.docx	11/28/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.