Information Collection

Validity Study of Intellectual and Disability Questions

IC 236041 under ICR 201807-0920-004 · OMB 0920-0222.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
GenIC 0920 0222 Validity Study Attach 1ab.doc	Other-WORD
GenIC 0920 0222 Validity Study Attach 3ab.doc	Other-WORD
GenIC 0920 0222 Validity Study Attach 5.doc	Other-WORD
GenIC 0920 0222 Validity Study Attach 2abc.doc Att 2a _ Advertisement/flyer	IC Document
Gen IC 0920 0222 Validity Study Attach 4.doc Att 4a_ Informed Consent	IC Document
GenIC 0920 0222 Validity Study Attach 6.doc Att 6_Thank You Letter	IC Document
GenIC 0920 0222 Validity Study 10-day letter.doc 10-Day Letter	IC Document

IC Title:

Validity Study of Intellectual and Disability Questions

Agency IC Tracking Number:

0920-0222-19AUI

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-WORD	GenIC 0920 0222 Validity Study Attach 1ab.doc	No	Paper Only
Other-WORD	GenIC 0920 0222 Validity Study Attach 3ab.doc	No	Paper Only
Other-WORD	GenIC 0920 0222 Validity Study Attach 5.doc	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 320

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	320	320
Annual IC Time Burden (Hours)	94	94
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 2a _ Advertisement/flyer	GenIC 0920 0222 Validity Study Attach 2abc.doc	05/23/2019
Att 4a_ Informed Consent	Gen IC 0920 0222 Validity Study Attach 4.doc	05/23/2019
Att 6_Thank You Letter	GenIC 0920 0222 Validity Study Attach 6.doc	05/23/2019
10-Day Letter	GenIC 0920 0222 Validity Study 10-day letter.doc	05/23/2019

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