Information Collection

Cognitive Testing of NSCH Questionnaire

IC 242679 under ICR 201909-0607-002 · OMB 0607-0725.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NSCH 2021 Screener Survey Cognitive Testing of NSCH Questionnaire	Form and Instruction
Form 2 NSCH 2021 Topical V1 Cognitive Testing of NSCH Questionnaire	Form and Instruction
Form 3 NSCH 2021 Topical V2 Cognitive Testing of NSCH Questionnaire	Form and Instruction
Form 4 NSCH 2021 Topical V3 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

IC Title:

Cognitive Testing of NSCH Questionnaire

Agency IC Tracking Number:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.