2018 NSCH Usability Evaluation

Generic Clearance for Questionnaire Pretesting Research

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0725 can be found here:

Documents and Forms

Document Name Document Type
Form 1 2018 NSCH Usability Evaluation Form and Instructi
1 Questionnaire V1 Enclosure 6S nschs1_18_021218.pdf Form and Instruction
2 Questionnaire V2 Enclosure 6T1 nscht1_18_020818.pdf Form and Instruction
3 Questionnaire V3 Enclosure 6T2 nscht2_18_020818.pdf Form and Instruction
4 Questionnaire V4 Enclosure 6T3 nscht3_18_020818.pdf Form and Instruction
5 Demographic Questionnaire Enclosure 2 Demographics.docx Form and Instruction
6 Satisfaction Questionnaire Enclosure 4 Satisfaction questionnaire.docx Form and Instruction
OMB letter - NSCH_Final_V2_3_23_2018.docx OMB Memo IC Document
Enclosure 1 2018 NSCH Protocol_Final.docx Protocol IC Document
Enclosure 3 Debriefing Slides.pptx Debriefing Slides IC Document
Enclosure 5 Screener_NSCH Questionnaire redesign.docx Recruiting Documents IC Document

Information Collection (IC) Details

IC Title:	2018 NSCH Usability Evaluation	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	1	Questionnaire V1	Enclosure 6S nschs1_18_021218.pdf	No	Fillable Fileable
Form and Instruction	2	Questionnaire V2	Enclosure 6T1 nscht1_18_020818.pdf	No	Fillable Fileable
Form and Instruction	3	Questionnaire V3	Enclosure 6T2 nscht2_18_020818.pdf	No	Fillable Fileable
Form and Instruction	4	Questionnaire V4	Enclosure 6T3 nscht3_18_020818.pdf	No	Fillable Fileable
Form and Instruction	5	Demographic Questionnaire	Enclosure 2 Demographics.docx	No	Fillable Fileable
Form and Instruction	6	Satisfaction Questionnaire	Enclosure 4 Satisfaction questionnaire.docx	No	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18	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	18	18
Annual IC Time Burden (Hours)	34	34
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo	OMB letter - NSCH_Final_V2_3_23_2018.docx	03/23/2018
Protocol	Enclosure 1 2018 NSCH Protocol_Final.docx	02/28/2018
Debriefing Slides	Enclosure 3 Debriefing Slides.pptx	02/28/2018
Recruiting Documents	Enclosure 5 Screener_NSCH Questionnaire redesign.docx	02/28/2018

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