Appendix A_Table 1 - Burden Table

Appendix A – Table 1

Table 1: Estimated Annualized Burden Hours

Type of Respondent	Form Name	No. of Respondents	No. Responses per Respondent	Average Burden per Response (in hours)	Burden Hours per Form		Total Burden Hours
Adult Parents- Puerto Rico	Screener	2,480	1	0.03	74.4	299.4
	Core	250	1	0.83	207.5
	Jurisdiction Module	250	1	0.07	17.5
Adult Parents- U.S. Virgin Islands	Screener	2,153	1	0.03	64.59	289.59
	Core	250	1	0.83	207.5
	Jurisdiction Module	250	1	0.07	17.5
Adult Parents- Guam	Screener	684	1	0.03	20.52	245.52
	Core	250	1	0.83	207.5
	Jurisdiction Module	250	1	0.07	17.5
Adult Parents- American Samoa	Screener	426	1	0.03	12.78	232.78
	Core	250	1	0.83	207.5
	Jurisdiction Module	250	1	0.05	12.5
Adult Parents- Federated States of Micronesia	Screener	339	1	0.03	10.17	230.17
	Core	250	1	0.83	207.5
	Jurisdiction Module	250	1	0.05	12.5
Adult Parents- Marshall Islands	Screener	284	1	0.03	8.52	236.02
	Core	250	1	0.83	207.5
	Jurisdiction Module	250	1	0.08	20
Adult Parents- Northern Mariana Islands	Screener	470	1	0.03	14.1	241.6
	Core	250	1	0.83	207.5
	Jurisdiction Module	250	1	0.08	20
Adult Parents- Palau	Screener	467	1	0.03	14.01	239.01
	Core	250	1	0.83	207.5
	Jurisdiction Module	250	1	0.02	17.5
Total		7,303				2014.09

Table 2: Sample Plan

	Northern Mariana Islands	American Samoa	Palau	Marshall Islands	Federated States of Micronesia	Puerto Rico	U.S. Virgin Islands	Guam
Target Population	Non-institutionalized children in housing units
Sampling Frame	Interval sampling (random walk method)
Within Household Selection	Select one screened child to be the subject of the topical interview
Target Sample Size	250	250	250	250	250	250	250	250
Estimated Sample
Addresses/housing units sampled	499	448	513	288	383	3,120	2,607	1141
Assumed screener completion rate	94%	95%	91%	99%	89%	79%	83%	60%
Screened for presence of children	470	426	467	284	339	2,480	2,153	684
Assumed eligibility rate	64%	73%	62%	93%	79%	19%	24%	49%
Child in household	303	312	289	263	268	467	512	332
Assumed interview completion rate	83%	80%	87%	95%	93%	54%	49%	75%
Completed interview	250	250	250	250	250	250	250	250
Response rate	78.1%	76.6%	75.4%	92.6%	83.0%	44.4%	41.1%	44.1%