NSCH Mail Materials Cognitive Testing

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⚠️ Notice: This information collection may be referencing outdated material.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 NSCH Mail Materials Cognitive Testing Form and Instructi
1 Mail Materials NSCH 2019 Mail Materials for Cognitive Testing_OMB.docx Form and Instruction
NSCH 2019 Mail Materials Cognitive Interviewing OMB Letter.docx OMB Memo IC Document
NSCH 2019 Mail Materials Cognitive Interviewing Protocol_OMB.docx Protocol IC Document
NSCH 2019 Mail Materials Consent form_OMB.doc Consent Form IC Document
NSCH 2019 Mail Materials Participant Screener_OMB.docx Telephone Screener IC Document
NSCH 2019 Mail Materials Screener Roster_OMB.docx Screener Roster IC Document
NSCH 2019 Mail Materials Voucher_OMB.docx Voucher IC Document

Information Collection (IC) Details

IC Title:	NSCH Mail Materials Cognitive Testing	Agency IC Tracking Number:

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
Form and Instruction	1	Mail Materials	NSCH 2019 Mail Materials for Cognitive Testing_OMB.docx		No		Paper Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	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	30	30
Annual IC Time Burden (Hours)	36	36
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo	NSCH 2019 Mail Materials Cognitive Interviewing OMB Letter.docx	07/09/2019
Protocol	NSCH 2019 Mail Materials Cognitive Interviewing Protocol_OMB.docx	07/09/2019
Consent Form	NSCH 2019 Mail Materials Consent form_OMB.doc	07/09/2019
Telephone Screener	NSCH 2019 Mail Materials Participant Screener_OMB.docx	07/09/2019
Screener Roster	NSCH 2019 Mail Materials Screener Roster_OMB.docx	07/09/2019
Voucher	NSCH 2019 Mail Materials Voucher_OMB.docx	07/09/2019

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