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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.