Information Collection

SUD Module Cognitive Interview Study

IC 231416 under ICR 201703-0930-001 · OMB 0930-0290.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0290 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Cognitive Intervie SUD Module Cognitive Interview Study	Form and Instruction
Cognitive Intervie Cognitive Interview Survey Questions NSDUH SUD Cog Int_PDF 5_Attachment I.pdf	Form and Instruction
SUD Module Cognitive Interview Study_OMB Supporting Statement_PART A_04 13 2018.docx Supporting Statement A	IC Document
SUD Module Cognitive Interview Study_OMB Supporting Statement_PART B_03 13 2018.docx Supporting Statement B	IC Document
NSDUH SUD Cog Int_PDF 1_Attachments A B C.pdf Recruitment	IC Document
NSDUH SUD Cog Int_PDF 2_Attachments D E.pdf Consent Forms	IC Document
NSDUH SUD Cog Int_PDF 3_Attachment F.pdf Protocol for Cognitive Interviews	IC Document
NSDUH SUD Cog Int_PDF 4_Attachments G H K.pdf Other Documents	IC Document
NSDUH SUD Cog Int_PDF 6_Attachment J.pdf Distressed Respondent Protocol	IC Document

IC Title:

SUD Module Cognitive Interview Study

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Cognitive Interview Survey Questions	Cognitive Interview Survey Questions	NSDUH SUD Cog Int_PDF 5_Attachment I.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	56	56
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	SUD Module Cognitive Interview Study_OMB Supporting Statement_PART A_04 13 2018.docx	05/10/2018
Supporting Statement B	SUD Module Cognitive Interview Study_OMB Supporting Statement_PART B_03 13 2018.docx	05/10/2018
Recruitment	NSDUH SUD Cog Int_PDF 1_Attachments A B C.pdf	05/10/2018
Consent Forms	NSDUH SUD Cog Int_PDF 2_Attachments D E.pdf	05/10/2018
Protocol for Cognitive Interviews	NSDUH SUD Cog Int_PDF 3_Attachment F.pdf	05/10/2018
Other Documents	NSDUH SUD Cog Int_PDF 4_Attachments G H K.pdf	05/10/2018
Distressed Respondent Protocol	NSDUH SUD Cog Int_PDF 6_Attachment J.pdf	05/10/2018

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