Information Collection

New Questions

IC 234097 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⚠️ Notice: This information collection may be referencing outdated material.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 Pre-test Questions New Questions	Form and Instruction
Pre-test Questions Pre-test Questions NSDUH Main Study Pretest_PDF 5_Attachment I.pdf	Form and Instruction
NSDUH Main Study Pretest_PDF 1_Attachments A B C.pdf Screeners	IC Document
NSDUH Main Study Pretest_PDF 2_Attachments D E.pdf Forms	IC Document
NSDUH Main Study Pretest_PDF 3_Attachment F.pdf Intro Script	IC Document
NSDUH Main Study Pretest_PDF 4_Attachments G H K.pdf Letters	IC Document
NSDUH Main Study Pretest_PDF 6_Attachment J.pdf Protocol	IC Document
NSDUH Main Study Pretest_Supporting Statement_PART A_10 09 2018.docx Supporting Statement - Part A	IC Document
NSDUH Main Study Pretest_Supporting Statement_PART B_11 20 2018.docx Supporting Statement - Part B	IC Document
NSDUH Main Study Pretest_Supporting Statement_PART A_3 11 2019.docx Supporting Statement A	IC Document
Attachment L Main Study Pretest Module.docx Main Study Pretest Module	IC Document

IC Title:

New Questions

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	Pre-test Questions	Pre-test Questions	NSDUH Main Study Pretest_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: 698

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	698	698
Annual IC Time Burden (Hours)	289	289
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Screeners	NSDUH Main Study Pretest_PDF 1_Attachments A B C.pdf	11/20/2018
Forms	NSDUH Main Study Pretest_PDF 2_Attachments D E.pdf	11/20/2018
Intro Script	NSDUH Main Study Pretest_PDF 3_Attachment F.pdf	11/20/2018
Letters	NSDUH Main Study Pretest_PDF 4_Attachments G H K.pdf	11/20/2018
Protocol	NSDUH Main Study Pretest_PDF 6_Attachment J.pdf	11/20/2018
Supporting Statement - Part A	NSDUH Main Study Pretest_Supporting Statement_PART A_10 09 2018.docx	11/20/2018
Supporting Statement - Part B	NSDUH Main Study Pretest_Supporting Statement_PART B_11 20 2018.docx	11/20/2018
Supporting Statement A	NSDUH Main Study Pretest_Supporting Statement_PART A_3 11 2019.docx	04/08/2019
Main Study Pretest Module	Attachment L Main Study Pretest Module.docx	04/08/2019

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