Collaborating Center for Questionnaire Design and Evaluation Research

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-21GG Follow Up Interview	Form and Instruction	New	Repair queued
Form 0920-21GG Data Collection Sheet	Form and Instruction	New	Repair queued
Form 0920-21GG Questionnaire	Form and Instruction	New	Repair queued
Form 0920-21GG Question Provenance	Form and Instruction	New	Repair queued
Form 0920-21GG Screener	Form and Instruction	New	Repair queued
Form 0920-0222 Respondent Debriefing Interview	Form and Instruction	New	Repair queued
Form 0920-0222 Respondent Data Collection Sheets - In-person/Virtual	Form and Instruction	New	Repair queued
Form 0920-0222 Questionnaire - uestions to be Cognitively tested	Form and Instruction	New	Repair queued
Form 0920-0222 Screener Parent/Guardian	Form and Instruction	New	Repair queued
Form 0920-0222 Respondent Screener	Form and Instruction	New	Repair queued
Form 0920-0222 Respondent Debriefing	Form and Instruction	New	Repair queued
Form 0920-0222 Respondent Data Collection Sheet	Form and Instruction	New	Repair queued
Form 0920-0222 Telephone screener - flyer and database	Form and Instruction	New	Repair queued
Form 0920-0222 Questionnaire 20 minute	Form and Instruction	New	Repair queued
Form 0920-0222 Questionnaire 55 minute	Form and Instruction	New	Repair queued
Follow-up Debriefing Discussion	Form and Instruction	New	Repair queued
Respondent Data Collection Sheet	Form and Instruction	New	Repair queued
Questions to be Cognitively Tested	Form and Instruction	New	Repair queued
Telephone Screening Script (for Parent / Guardian)	Form and Instruction	New	Repair queued
Telephone Screening Script (for Target Respondents)	Form and Instruction	New	Repair queued
Form 0920-0222 RANDS NSFG Web Questionnaire	Form and Instruction	New	Repair queued
Form 1 Test Questions	Form	New	Repair queued
Form 0920-21EC Respondent Debriefing	Form	New	Repair queued
Form 0920-21EC Virtual Interviews Data collection Sheet	Form and Instruction	New	Repair queued
Form 0920-21EC Telephone Screener	Form and Instruction	New	Repair queued
Respondent Data Collection Sheet [demographics]	Form and Instruction	New	Available
NHIS Complementary Health Approaches and Well-being Questionnaire	Form and Instruction	New	Available
Telephone Screener	Form and Instruction	New	Available
Respondent data sheet	Form and Instruction	New	Available
NIOSH questionnaire	Form and Instruction	New	Available
Telephone screener	Form and Instruction	New	Available
Form 0920-0222 Respondent Data Collection Sheet	Form	New	Available
Form 0920-0222 Questions for Consideration NHIS-OHS 2021 Supplement	Form	New	Available
Data Collection Sheet (participant demographics)	Form and Instruction	New	Available
Focus Group Protocol (NHANES Growth Chart)	Form and Instruction	New	Available
Form 0920-0222 Attachment 5: Respondent Data Collection Sheet	Form and Instruction	New	Available
Form 0920-0222 Attachment 3b – Telephone Screening Script – Respondent recruited from CCQDER Respondent Database	Form and Instruction	New	Available
Form 0920-0222 Attachment 3a – Telephone Screening Script – Respondent recruited from newspaper advertisement/flyer	Form and Instruction	New	Available
Form 0920-0222 Attachment 1b - Life History Calendar Worksheet (Recall Aide)	Form and Instruction	New	Available
Form 0920-0222 Attachment 1a: Questions to be cognitively tested	Form and Instruction	New	Available
Respondent data collection sheets	Form	New	Available
Interview instrument	Form	New	Available
Telephone screeners	Form and Instruction	New	Available
Respondent Data Sheet (in Spanish)	Form and Instruction	New	Available
PRAMS 2019 questions to be cognitively tested (Phone/Spanish version)	Form and Instruction	New	Available
Telephone Screening Script (in Spansih)	Form and Instruction	New	Available
Respondent data collection sheet	Form	New	Available
National Survey on Best Practices for Patient Pain Management and Opioid Use	Form	New	Available
Form 0920-0222 Respondent Data	Form and Instruction	New	Available
Form 0920-0222 Screener	Form and Instruction	New	Repair queued
Form 0920-0222 2019 Questions for Cognitive Testing	Form and Instruction	New	Available
Form 0920-0222 Respondent Data Collection Sheet	Form and Instruction	New	Available
Form 0920-0222 Screeners	Form and Instruction	New	Available
Form 0920-0222 Questions to be Cognitively Tested	Form and Instruction	New	Available
Respondent Data Collection Sheet (Demographics)	Form and Instruction	New	Available
ACS Booklet and Selected NHIS Questions Discussed During the Cognitive Interview	Form and Instruction	New	Available
Telephone Screener	Form and Instruction	New	Available
Form 0920-0222 Web Questionnaire Introduction Screen and RANDS Questionnaire	Form and Instruction	New	Available
Respondent Data Collection Sheet	Form	New	Available
Telephone Screener - Spanish	Form	New	Repair queued
PRAMS Opioid 2018 - Spanish	Form	New	Available
Respondent Data Sheet	Form	New	Available
Telephone Screener	Form	New	Repair queued
PRAMS Opioid 2018	Form	New	Available
qvideo_PIA_signed.pdf	Supplementary Document	Uploaded 2018-07-24	Available
Privacy Act App Review CCQDER 062918.docx	Supplementary Document	Uploaded 2018-07-12	Available
Att N Explain cog interview 062718.doc	Supplementary Document	Uploaded 2018-07-12	Available
Att M Sample Resp data collect sheet 070218.doc	Supplementary Document	Uploaded 2018-07-12	Available
Att L Sample advance letter.doc	Supplementary Document	Uploaded 2018-07-12	Available
Att K Voice mail script.doc	Supplementary Document	Uploaded 2018-07-12	Available
Att J Sample newspaper adv.doc	Supplementary Document	Uploaded 2018-07-12	Available
Att I Sample flyer.doc	Supplementary Document	Uploaded 2018-07-12	Repair queued
Att H NCHS ERB approval.rtf	Supplementary Document	Uploaded 2018-07-12	Available
Att G Spec consent focus group 062718.docx	Supplementary Document	Uploaded 2018-07-12	Available
Att F Spec consent Cog Int 062718.docx	Supplementary Document	Uploaded 2018-07-12	Available
Att E informed consent 062718.doc	Supplementary Document	Uploaded 2018-07-12	Available
Att D screening script 062718.doc	Supplementary Document	Uploaded 2018-07-12	Repair queued
Att C Nondisclosure Affidavits 062718.doc	Supplementary Document	Uploaded 2018-07-12	Available
Att B 60-Day Notice 062718.pdf	Supplementary Document	Uploaded 2018-07-12	Available
Supp Statement A clean 070218 ICRO edited.docx	Supporting Statement A	Uploaded 2018-07-12	Available
Att A Pub Health Serv Act.doc	Supplementary Document	Uploaded 2015-06-11	Available
Supp Statement B 070218.docx	Supporting Statement B	Uploaded 2018-07-12	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
248693	Cannabis Questions	Form and Instruction	New	Follow Up Interview
248693	Cannabis Questions	Form and Instruction	New	Data Collection Sheet
248693	Cannabis Questions	Form and Instruction	New	Questionnaire
248693	Cannabis Questions	Form and Instruction	New	Question Provenance
248693	Cannabis Questions	Form and Instruction	New	Screener
248459	Cognitive Testing of Adverse Childhood Events Questions for the Youth Risk Behavior Surveillance System (YRBSS)	Form and Instruction	New	Respondent Debriefing Interview
248459	Cognitive Testing of Adverse Childhood Events Questions for the Youth Risk Behavior Surveillance System (YRBSS)	Form and Instruction	New	Respondent Data Collection Sheets - In-person/Virtual
248459	Cognitive Testing of Adverse Childhood Events Questions for the Youth Risk Behavior Surveillance System (YRBSS)	Form and Instruction	New	Questionnaire - uestions to be Cognitively tested
248459	Cognitive Testing of Adverse Childhood Events Questions for the Youth Risk Behavior Surveillance System (YRBSS)	Form and Instruction	New	Screener Parent/Guardian
248459	Cognitive Testing of Adverse Childhood Events Questions for the Youth Risk Behavior Surveillance System (YRBSS)	Form and Instruction	New	Respondent Screener
248459	Cognitive Testing of Adverse Childhood Events Questions for the Youth Risk Behavior Surveillance System (YRBSS)	Other-Virtual interview Zoom/Skype set up support	New
248162	RANDS - NISVS	Form and Instruction	New	Respondent Debriefing
248162	RANDS - NISVS	Form and Instruction	New	Respondent Data Collection Sheet
248162	RANDS - NISVS	Form and Instruction	New	Telephone screener - flyer and database
248162	RANDS - NISVS	Form and Instruction	New	Questionnaire 20 minute
248162	RANDS - NISVS	Form and Instruction	New	Questionnaire 55 minute
248018	Cognitive Testing of Occupational Safety and Health Questions for the Youth Risk Behavior Surveillance System (YRBSS) [with incentive level test]	Form and Instruction	New	Follow-up Debriefing Discussion
248018	Cognitive Testing of Occupational Safety and Health Questions for the Youth Risk Behavior Surveillance System (YRBSS) [with incentive level test]	Form and Instruction	New	Respondent Data Collection Sheet
248018	Cognitive Testing of Occupational Safety and Health Questions for the Youth Risk Behavior Surveillance System (YRBSS) [with incentive level test]	Form and Instruction	New	Questions to be Cognitively Tested
248018	Cognitive Testing of Occupational Safety and Health Questions for the Youth Risk Behavior Surveillance System (YRBSS) [with incentive level test]	Form and Instruction	New	Telephone Screening Script (for Parent / Guardian)
248018	Cognitive Testing of Occupational Safety and Health Questions for the Youth Risk Behavior Surveillance System (YRBSS) [with incentive level test]	Form and Instruction	New	Telephone Screening Script (for Target Respondents)
248018	Cognitive Testing of Occupational Safety and Health Questions for the Youth Risk Behavior Surveillance System (YRBSS) [with incentive level test]	Other-Virtual Interview Setup Support [see Sections III and IV]	New
248008	RANDS NSFG	Form and Instruction	New	RANDS NSFG Web Questionnaire
246525	NSFG Testing	Form	New	Test Questions
246525	NSFG Testing	Form	New	Respondent Debriefing
246525	NSFG Testing	Form and Instruction	New	Virtual Interviews Data collection Sheet
246525	NSFG Testing	Form and Instruction	New	Telephone Screener
244069	NSCH "Healthy and Ready to Learn" Questions 2020 (Self-administered/English)	Other-WORD	New
243885	Cognitive Testing of Questions on Complementary Health Approaches and Well-being	Form and Instruction	New	Respondent Data Collection Sheet [demographics]
243885	Cognitive Testing of Questions on Complementary Health Approaches and Well-being	Form and Instruction	New	NHIS Complementary Health Approaches and Well-being Questionnaire
243885	Cognitive Testing of Questions on Complementary Health Approaches and Well-being	Form and Instruction	New	Telephone Screener
243825	NIOSH Virtual Cognitive Interview Study	Form and Instruction	New	Respondent data sheet
243825	NIOSH Virtual Cognitive Interview Study	Form and Instruction	New	NIOSH questionnaire
243825	NIOSH Virtual Cognitive Interview Study	Form and Instruction	New	Telephone screener
240112	Cognitive Testing of 2021 Occupational Health Supplement Questions	Form	New	Respondent Data Collection Sheet
240112	Cognitive Testing of 2021 Occupational Health Supplement Questions	Form	New	Questions for Consideration NHIS-OHS 2021 Supplement
240112	Cognitive Testing of 2021 Occupational Health Supplement Questions	Instruction	New
239465	The Research and Development Survey (RANDS 4 -- Telephone Sample)	Other-WORD	New
239376	National Health and Nutrition Examination Survey (NHANES – Growth Chart)	Form and Instruction	New	Data Collection Sheet (participant demographics)
239376	National Health and Nutrition Examination Survey (NHANES – Growth Chart)	Form and Instruction	New	Focus Group Protocol (NHANES Growth Chart)
238942	NSFG Life History Calendar Evaluation	Form and Instruction	New	Attachment 5: Respondent Data Collection Sheet
238942	NSFG Life History Calendar Evaluation	Form and Instruction	New	Attachment 3b – Telephone Screening Script – Respondent recruited from CCQDER Respondent Database
238942	NSFG Life History Calendar Evaluation	Form and Instruction	New	Attachment 3a – Telephone Screening Script – Respondent recruited from newspaper advertisement/flyer
238942	NSFG Life History Calendar Evaluation	Form and Instruction	New	Attachment 1b - Life History Calendar Worksheet (Recall Aide)
238942	NSFG Life History Calendar Evaluation	Form and Instruction	New	Attachment 1a: Questions to be cognitively tested
237460	Cognitive Testing for American Community Survey	Form	New	Respondent data collection sheets
237460	Cognitive Testing for American Community Survey	Form	New	Interview instrument
237460	Cognitive Testing for American Community Survey	Form and Instruction	New	Telephone screeners
236479	Cognitive Interview Study: Spanish-language Telephone-administered Questions for PRAMS (2019)	Form and Instruction	New	Respondent Data Sheet (in Spanish)
236479	Cognitive Interview Study: Spanish-language Telephone-administered Questions for PRAMS (2019)	Form and Instruction	New	PRAMS 2019 questions to be cognitively tested (Phone/Spanish version)
236479	Cognitive Interview Study: Spanish-language Telephone-administered Questions for PRAMS (2019)	Form and Instruction	New	Telephone Screening Script (in Spansih)
236379	Cognitive Testing of Physician Opioid Questions	Form	New	Respondent data collection sheet
236379	Cognitive Testing of Physician Opioid Questions	Form	New	National Survey on Best Practices for Patient Pain Management and Opioid Use
236379	Cognitive Testing of Physician Opioid Questions	Other-Telephone script	New
236175	Cognitive Test for the Pregnancy Risk Assessment Monitoring System (PRAMS)	Form and Instruction	New	Respondent Data
236175	Cognitive Test for the Pregnancy Risk Assessment Monitoring System (PRAMS)	Form and Instruction	New	Screener
236175	Cognitive Test for the Pregnancy Risk Assessment Monitoring System (PRAMS)	Form and Instruction	New	2019 Questions for Cognitive Testing
236133	Cognitive Test for NHIS Questions and Opiods	Form and Instruction	New	Respondent Data Collection Sheet
236133	Cognitive Test for NHIS Questions and Opiods	Form and Instruction	New	Screeners
236133	Cognitive Test for NHIS Questions and Opiods	Form and Instruction	New	Questions to be Cognitively Tested
236115	Cognitive Test for ACS Disability Questions and NHIS Child Behavior Questions	Form and Instruction	New	Respondent Data Collection Sheet (Demographics)
236115	Cognitive Test for ACS Disability Questions and NHIS Child Behavior Questions	Form and Instruction	New	ACS Booklet and Selected NHIS Questions Discussed During the Cognitive Interview
236115	Cognitive Test for ACS Disability Questions and NHIS Child Behavior Questions	Form and Instruction	New	Telephone Screener
236041	Validity Study of Intellectual and Disability Questions	Other-WORD	New
233931	NCHS Research and Development Survey (RANDS)	Form and Instruction	New	Web Questionnaire Introduction Screen and RANDS Questionnaire
233753	PRAMS Opioid 2018 -Spanish	Form	New	Respondent Data Collection Sheet
233753	PRAMS Opioid 2018 -Spanish	Form	New	Telephone Screener - Spanish
233753	PRAMS Opioid 2018 -Spanish	Form	New	PRAMS Opioid 2018 - Spanish
233751	PRAMS Opioid 2018 - English	Form	New	Respondent Data Sheet
233751	PRAMS Opioid 2018 - English	Form	New	Telephone Screener
233751	PRAMS Opioid 2018 - English	Form	New	PRAMS Opioid 2018

ICR Details

OMB Control No: 0920-0222	ICR Reference No: 201807-0920-004
Status: Historical Active	Previous ICR Reference No: 201506-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0222
Title: Collaborating Center for Questionnaire Design and Evaluation Research
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/31/2018
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/27/2018
Terms of Clearance: CDC will continue to submit individual collections under this generic clearance to OMB. OMB will strive to provide feedback on the individual collections within ten working days, whenever possible, as is currently the case. Standard remuneration of respondents for cognitive testing ($40) and focus groups ($75) applies until research is presented suggesting these rates should be changed or in situation where evidence already exists that a particular subpopulation requires a higher incentive.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2021	36 Months From Approved	08/31/2018
Responses	56,100	0	24,000
Time Burden (Hours)	23,350	0	13,150
Cost Burden (Dollars)	0	0	0

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Abstract: This generic clearance request encompasses general questionnaire development, pre-testing, measurement-error reduction activities to be carried out in 2018-2021 in the Division of Research and Methodology, National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC). The revision requested consists of an increase in burden hours for the next 3-year approval period. The difference is due to an anticipated increase in the number and size of projects being undertaken.

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Authorizing Statute(s): US Code: 42 USC 242k Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 8875	03/01/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 35646	07/27/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 23

table that charts list of burden

IC Title	Form No.	Form Name
Cannabis Questions	0920-21GG, 0920-21GG, 0920-21GG, 0920-21GG, 0920-21GG	Screener ,   Question Provenance ,   Questionnaire ,   Data Collection Sheet ,   Follow Up Interview
Cognitive Interview Study: Spanish-language Telephone-administered Questions for PRAMS (2019)	n/a, n/a, n/a	Telephone Screening Script (in Spansih) ,   PRAMS 2019 questions to be cognitively tested (Phone/Spanish version) ,   Respondent Data Sheet (in Spanish)
Cognitive Test for ACS Disability Questions and NHIS Child Behavior Questions	n/a, n/a, n/a	Telephone Screener ,   ACS Booklet and Selected NHIS Questions Discussed During the Cognitive Interview ,   Respondent Data Collection Sheet (Demographics)
Cognitive Test for NHIS Questions and Opiods	0920-0222, 0920-0222, 0920-0222	Questions to be Cognitively Tested ,   Screeners ,   Respondent Data Collection Sheet
Cognitive Test for the Pregnancy Risk Assessment Monitoring System (PRAMS)	0920-0222, 0920-0222, 0920-0222	2019 Questions for Cognitive Testing ,   Screener ,   Respondent Data
Cognitive Testing for American Community Survey	none, none, none	Telephone screeners ,   Interview instrument ,   Respondent data collection sheets
Cognitive Testing of 2021 Occupational Health Supplement Questions	0920-0222, 0920-0222	Questions for Consideration NHIS-OHS 2021 Supplement ,   Respondent Data Collection Sheet
Cognitive Testing of Adverse Childhood Events Questions for the Youth Risk Behavior Surveillance System (YRBSS)	0920-0222, 0920-0222, 0920-0222, 0920-0222, 0920-0222	Respondent Screener ,   Screener Parent/Guardian ,   Questionnaire - uestions to be Cognitively tested ,   Respondent Data Collection Sheets - In-person/Virtual ,   Respondent Debriefing Interview
Cognitive Testing of Occupational Safety and Health Questions for the Youth Risk Behavior Surveillance System (YRBSS) [with incentive level test]	n/a, n/a, n/a, n/a, n/a	Telephone Screening Script (for Target Respondents) ,   Telephone Screening Script (for Parent / Guardian) ,   Questions to be Cognitively Tested ,   Respondent Data Collection Sheet ,   Follow-up Debriefing Discussion
Cognitive Testing of Physician Opioid Questions	none, none	National Survey on Best Practices for Patient Pain Management and Opioid Use ,   Respondent data collection sheet
Cognitive Testing of Questions on Complementary Health Approaches and Well-being	n/a, n/a, n/a	Telephone Screener ,   NHIS Complementary Health Approaches and Well-being Questionnaire ,   Respondent Data Collection Sheet [demographics]
NCHS Research and Development Survey (RANDS)	0920-0222	Web Questionnaire Introduction Screen and RANDS Questionnaire
NIOSH Virtual Cognitive Interview Study	none, none, none	Telephone screener ,   NIOSH questionnaire ,   Respondent data sheet
NSCH "Healthy and Ready to Learn" Questions 2020 (Self-administered/English)
NSFG Life History Calendar Evaluation	0920-0222, 0920-0222, 0920-0222, 0920-0222, 0920-0222	Attachment 1a: Questions to be cognitively tested ,   Attachment 1b - Life History Calendar Worksheet (Recall Aide) ,   Attachment 3a – Telephone Screening Script – Respondent recruited from newspaper advertisement/flyer ,   Attachment 3b – Telephone Screening Script – Respondent recruited from CCQDER Respondent Database ,   Attachment 5: Respondent Data Collection Sheet
NSFG Testing	0920-21EC, 0920-21EC, 0920-21EC, 1	Telephone Screener ,   Virtual Interviews Data collection Sheet ,   Respondent Debriefing ,   Test Questions
National Health and Nutrition Examination Survey (NHANES – Growth Chart)	n/a, n/a	Focus Group Protocol (NHANES Growth Chart) ,   Data Collection Sheet (participant demographics)
PRAMS Opioid 2018 - English	none, none, none	PRAMS Opioid 2018 ,   Telephone Screener ,   Respondent Data Sheet
PRAMS Opioid 2018 -Spanish	none, none, none	PRAMS Opioid 2018 - Spanish ,   Telephone Screener - Spanish ,   Respondent Data Collection Sheet
RANDS - NISVS	0920-0222, 0920-0222, 0920-0222, 0920-0222, 0920-0222	Questionnaire 55 minute ,   Questionnaire 20 minute ,   Telephone screener - flyer and database ,   Respondent Data Collection Sheet ,   Respondent Debriefing
RANDS NSFG	0920-0222	RANDS NSFG Web Questionnaire
The Research and Development Survey (RANDS 4 -- Telephone Sample)
Validity Study of Intellectual and Disability Questions

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	56,100	24,000	0	32,100	0	0
Annual Time Burden (Hours)	23,350	13,150	0	10,200	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The increase in burden is due to an anticipated increase in the number and size of projects being undertaken.

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Annual Cost to Federal Government: $2,229,740

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/27/2018

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