Cognitive Testing of ASPE Criminal Justice System Questions

NCHS Questionnaire Design Research Laboratory

⚠️ Notice: This information collection may be referencing outdated material.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
Attachment 1a - Instrument 092117.docx Other-WORD
Attachment 3 - Telephone Screener 092117.docx Other-WORD
Attachment 1b- Item Justification 092117.docx Att 1b_Survey Questions Reference/Justification IC Document
Attachment 2 - AdvFlyer 092117.docx Att 2_Advertisement Flyer IC Document
Attachment 4 - Resp Data Collect Sheet 092117.docx Att 4_Respondent Data Collection Sheet IC Document
Attachment 5 - Informed Consent 092117.docx Att 5_Adult Informed Consent IC Document
Attachment 6 - Thank You Letter.docx Att 6_Thank you letter IC Document
10-day letter ASPE Criminal Justice 121917.docx 10 day Letter IC Document

Information Collection (IC) Details

IC Title:	Cognitive Testing of ASPE Criminal Justice System Questions	Agency IC Tracking Number:	0920-0222 (18JY)

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Attachment 1a - Instrument 092117.docx		No		Paper Only
Other-WORD			Attachment 3 - Telephone Screener 092117.docx		No		Fillable Printable

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 th US Population	FR Citation: 49 FR 37693

Number of Respondents: 117	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	117	117
Annual IC Time Burden (Hours)	45	45
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 1b_Survey Questions Reference/Justification	Attachment 1b- Item Justification 092117.docx	12/20/2017
Att 2_Advertisement Flyer	Attachment 2 - AdvFlyer 092117.docx	12/20/2017
Att 4_Respondent Data Collection Sheet	Attachment 4 - Resp Data Collect Sheet 092117.docx	12/20/2017
Att 5_Adult Informed Consent	Attachment 5 - Informed Consent 092117.docx	12/20/2017
Att 6_Thank you letter	Attachment 6 - Thank You Letter.docx	12/20/2017
10 day Letter	10-day letter ASPE Criminal Justice 121917.docx	01/02/2018

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