Information Collection

Cognitive Testing of Questions on Complementary Health Approaches and Well-being

IC 243885 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⚠️ Notice: This information collection may be referencing outdated material.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
Cognitive Testing of Questions on Complementary Health Approaches and Well-being	Form and Instruction
Telephone Screener Att3ab-CAM Telephone Screener.docx	Form and Instruction
NHIS Complementary Health Approaches and Well-being Ques Att1-CAM Questionnaire.docx	Form and Instruction
Respondent Data Collection Sheet [demographics] Att5ab-CAM Resp Data Collect.docx	Form and Instruction
10-day letter CAM NHIS 9.29.2020v2.docx Project Justification and Description	IC Document
Att2ab-CAM Ad&flyer.docx Recruitment Ads/Flyers	IC Document
Att4ab-CAM Informed Consent.docx Informed Consent	IC Document
Att6-CAM Thank You Letter.docx Thank You Letter to Participants	IC Document

IC Title:

Cognitive Testing of Questions on Complementary Health Approaches and Well-being

Agency IC Tracking Number:

0920-20SN

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	Available Electronically?	Electronic Capability
Form and Instruction	n/a	Telephone Screener	Att3ab-CAM Telephone Screener.docx	No	Paper Only
Form and Instruction	n/a	NHIS Complementary Health Approaches and Well-being Questionnaire	Att1-CAM Questionnaire.docx	No	Paper Only
Form and Instruction	n/a	Respondent Data Collection Sheet [demographics]	Att5ab-CAM Resp Data Collect.docx	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population

FR Citation: 49 FR 37693

Number of Respondents: 140

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	140	140
Annual IC Time Burden (Hours)	55	55
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Project Justification and Description	10-day letter CAM NHIS 9.29.2020v2.docx	10/05/2020
Recruitment Ads/Flyers	Att2ab-CAM Ad&flyer.docx	10/05/2020
Informed Consent	Att4ab-CAM Informed Consent.docx	10/05/2020
Thank You Letter to Participants	Att6-CAM Thank You Letter.docx	10/05/2020

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