NSCH Questionnaire Cognitive Interviews

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⚠️ Notice: This information collection may be referencing outdated material.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 Questionnaire Cognitive Interviews Form and Instructi
1 Screener Survey NSCH Screener Survey.pdf Form and Instruction
2 Cognitive Interview Version 1 nscht1_20_092319.pdf Form and Instruction
3 Cognitive Interview Version 2 nscht2_20_092319.pdf Form and Instruction
4 Cognitive Interview Version 3 nscht3_20_092319.pdf Form and Instruction
NSCH 2019 Content Cognitive Interviewing Letter_OMB.docx OMB Memo IC Document
NSCH 2019 Content Cognitive Interviewing Protocol_OMB_revised_09232019.docx Protocol IC Document
NSCH 2019 Content Consent form_OMB.doc Consent Form IC Document
NSCH 2019 Content Participant Screener_OMB.docx Recruitment Screener IC Document
NSCH 2019 Content Voucher_OMB.docx Voucher Form IC Document

Information Collection (IC) Details

IC Title:	NSCH Questionnaire Cognitive Interviews	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	Screener Survey	NSCH Screener Survey.pdf	No	Fillable Fileable
Form and Instruction	2	Cognitive Interview Version 1	nscht1_20_092319.pdf	No	Fillable Fileable
Form and Instruction	4	Cognitive Interview Version 3	nscht3_20_092319.pdf	No	Fillable Fileable
Form and Instruction	3	Cognitive Interview Version 2	nscht2_20_092319.pdf	No	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	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	54	54
Annual IC Time Burden (Hours)	65	65
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo	NSCH 2019 Content Cognitive Interviewing Letter_OMB.docx	07/24/2019
Protocol	NSCH 2019 Content Cognitive Interviewing Protocol_OMB_revised_09232019.docx	09/25/2019
Consent Form	NSCH 2019 Content Consent form_OMB.doc	07/24/2019
Recruitment Screener	NSCH 2019 Content Participant Screener_OMB.docx	07/24/2019
Voucher Form	NSCH 2019 Content Voucher_OMB.docx	07/24/2019

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