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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.