Information Collection Request

Cognitive Testing and Pilot Testing for the National Center for Chronic Disease Prevention and Health Promotion

ICR 202009-0920-019 · OMB 0920-1291 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-1291 Electronic Health Records and Address- Based Sampling Pilots Form and Instruction New Available
0920 1291 Chg Req 11-12-2020.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-11-12 Available
NCCDPHP GCT SSA 12-16-2019 (2).docx Supporting Statement A Uploaded 2019-12-16 Available
Att 9. NCCDPHP GCT Cover Form Final.docx Supplementary Document Uploaded 2019-12-16 Available
Att 7. NCCDPHP GCT Multimode Pilot Final Report Final.docx Supplementary Document Uploaded 2019-12-16 Available
Att 6. NCCDPHP GCT Screener to Participate in Cognitive Testing Exam Final.docx Supplementary Document Uploaded 2019-12-16 Available
Att 5. NCCDPHP GCT Vendor Cognitive Testing Rpt Exam Final.docx Supplementary Document Uploaded 2019-12-16 Available
Att 4. NCCDPHP GCT NCCDPHP Divisions Final.docx Supplementary Document Uploaded 2019-12-16 Available
Att 3. NCCDPHP GCT Quest Proposal Proc Exam from the BRFSS Final.docx Supplementary Document Uploaded 2019-12-16 Available
Att 2. Published 60-day FRN Final.pdf Supplementary Document Uploaded 2019-12-16 Available
Att 1. NCCDPHP GCT Authorizing Legislation Final.pdf Supplementary Document Uploaded 2019-12-16 Available
NCCDPHP GCT SSB Final.docx Supporting Statement B Uploaded 2019-12-16 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
245344 Electronic Health Records and Address- Based Sampling Pilots Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2023 03/31/2023 03/31/2023
270,300 0 52,500
35,850 0 26,850
658,900 0 658,900






table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 270,300 52,500 0 217,800 0 0
Annual Time Burden (Hours) 35,850 26,850 0 9,000 0 0
Annual Cost Burden (Dollars) 658,900 658,900 0 0 0 0


Reginfo record details
  No