NHANES Contact and Message Testing

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⚠️ Notice: This information collection may be referencing outdated material.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 1 - Focus Group Protocol rev 020218.docx Other-ord
Attachment 3 - Screener.docx Other-SCREENER
Attachment 2 - Advertisement.docx Att 2_Advertisement/Flyer IC Document
Attachment 4 - Consent.docx Att 4_Adult Informed Consent IC Document
Attachment 5 - Respondent Data Collection Sheet.docx Att 5_Respondent Data CollectionSheet IC Document
Attachment 6 - Thank You Letter.docx Att 6_Focus Group Thank you Letter IC Document
Attachment 7 - Current NHANES Contact Material.pdf Att 7_Current Contact Protocol IC Document
Attachment 8 - Proposed NHANES Contact Material 02 07 2018.pdf Att 8_Proposed NHANES Contact and Materials IC Document
NHANES Focus Group 10 day letter 021618.docx Focus Group 10-Day Letter (Request for Approval 0920-0222 18QO) IC Document

Information Collection (IC) Details

IC Title:	NHANES Contact and Message Testing	Agency IC Tracking Number:	0920-0222 (18QO)

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-ord			Attachment 1 - Focus Group Protocol rev 020218.docx		No		Paper Only
Other-SCREENER			Attachment 3 - Screener.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

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

Number of Respondents: 164	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	164	164
Annual IC Time Burden (Hours)	105	105
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 2_Advertisement/Flyer	Attachment 2 - Advertisement.docx	02/20/2018
Att 4_Adult Informed Consent	Attachment 4 - Consent.docx	02/20/2018
Att 5_Respondent Data CollectionSheet	Attachment 5 - Respondent Data Collection Sheet.docx	02/20/2018
Att 6_Focus Group Thank you Letter	Attachment 6 - Thank You Letter.docx	02/20/2018
Att 7_Current Contact Protocol	Attachment 7 - Current NHANES Contact Material.pdf	02/20/2018
Att 8_Proposed NHANES Contact and Materials	Attachment 8 - Proposed NHANES Contact Material 02 07 2018.pdf	02/20/2018
Focus Group 10-Day Letter (Request for Approval 0920-0222 18QO)	NHANES Focus Group 10 day letter 021618.docx	02/20/2018

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