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

Collaborating Center for Questionnaire Design and Evaluation Research

⚠️ Notice: This information collection may be referencing outdated material.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

Information Collection (IC) Details

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:

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 %

	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

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.