Information Collection

NSCH Questionnaire Cognitive Interviews

IC 237067 under ICR 201606-0607-003 · OMB 0607-0725.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

NSCH Questionnaire Cognitive Interviews

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.