Cognitive Testing of NSCH Questionnaire

Generic Clearance for Questionnaire Pretesting Research

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0725 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Cognitive Testing of NSCH Questionnaire Form and Instruction
1 NSCH 2021 Screener Survey NSCH 2021 Screener Survey_Cognitive Interviewing Version.pdf Form and Instruction
2 NSCH 2021 Topical V1 NSCH 2021 T1_Cognitive Interviewing Version.pdf Form and Instruction
3 NSCH 2021 Topical V2 NSCH 2021 T2_Cognitive Interviewing Version.pdf Form and Instruction
4 NSCH 2021 Topical V3 NSCH 2021 T3_Cognitive Interviewing Version.pdf Form and Instruction
NSCH 2021 Content Cognitive Interviewing Letter_FINAL_REVISED.docx OMB Letter IC Document
NSCH 2021 Content Cognitive Interviewing Participant Screener_FINAL_OMB.docx Screener IC Document
NSCH 2021 Content Cognitive Interviewing Consent Form_FINAL_OMB.docx Consent Form IC Document
NSCH 2021 Content Cognitive Interviewing Protocol_FINAL_OMB.docx Protocol IC Document

Information Collection (IC) Details

IC Title:	Cognitive Testing of NSCH Questionnaire	Agency IC Tracking Number:

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	1	NSCH 2021 Screener Survey	NSCH 2021 Screener Survey_Cognitive Interviewing Version.pdf	No	Fillable Fileable
Form and Instruction	2	NSCH 2021 Topical V1	NSCH 2021 T1_Cognitive Interviewing Version.pdf	No	Fillable Fileable
Form and Instruction	3	NSCH 2021 Topical V2	NSCH 2021 T2_Cognitive Interviewing Version.pdf	No	Fillable Fileable
Form and Instruction	4	NSCH 2021 Topical V3	NSCH 2021 T3_Cognitive Interviewing Version.pdf	No	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	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	40	40
Annual IC Time Burden (Hours)	48	48
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Letter	NSCH 2021 Content Cognitive Interviewing Letter_FINAL_REVISED.docx	08/31/2020
Screener	NSCH 2021 Content Cognitive Interviewing Participant Screener_FINAL_OMB.docx	07/14/2020
Consent Form	NSCH 2021 Content Cognitive Interviewing Consent Form_FINAL_OMB.docx	07/14/2020
Protocol	NSCH 2021 Content Cognitive Interviewing Protocol_FINAL_OMB.docx	07/14/2020

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