Collaborating Center for Questionnaire Design and Evaluation Research

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Att O Thank You Letter.docx	Supplementary Document	Uploaded 2021-08-03	Repair queued
Att N Explain Cog Interview.docx	Supplementary Document	Uploaded 2021-08-03	Missing upstream
Att M Sample Resp Data Collect Sheet.docx	Supplementary Document	Uploaded 2021-08-03	Repair queued
Att L Sample Advance Letter.docx	Supplementary Document	Uploaded 2021-08-03	Missing upstream
Att K Voice mail script.docx	Supplementary Document	Uploaded 2021-08-03	Repair queued
Att J Sample newspaper adv.docx	Supplementary Document	Uploaded 2021-08-03	Repair queued
Att I Sample flyer.docx	Supplementary Document	Uploaded 2021-08-03	Repair queued
Att H-1&H-2 IRB Approval Documentation.docx	Supplementary Document	Uploaded 2021-08-03	Repair queued
Att G Spec Consent Focus Group.docx	Supplementary Document	Uploaded 2021-08-03	Repair queued
Att F Spec Consent Cog Int.docx	Supplementary Document	Uploaded 2021-08-03	Repair queued
Att E Informed Consent.docx	Supplementary Document	Uploaded 2021-08-03	Repair queued
Att D Screening Script.docx	Supplementary Document	Uploaded 2021-08-03	Available
Att C Nondisclosure Affidavit.docx	Supplementary Document	Uploaded 2021-08-03	Repair queued
Att B Published 60-Day FRN.pdf	Supplementary Document	Uploaded 2021-08-03	Repair queued
Att A Public Health Serv Act.docx	Supplementary Document	Uploaded 2021-08-03	Missing upstream
SSB_0222_07282021.docx	Supporting Statement B	Uploaded 2021-08-03	Repair queued
SSA_0222_07292021.docx	Supporting Statement A	Uploaded 2021-08-03	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
250398	Gender X Marker	Other-Draft Modified Form with Questions to be Tested	New

ICR Details

OMB Control No: 0920-0222	ICR Reference No: 202107-0920-010
Status: Received in OIRA	Previous ICR Reference No: 201807-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0222
Title: Collaborating Center for Questionnaire Design and Evaluation Research
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/16/2021

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	08/31/2021
Responses	66,375	56,100
Time Burden (Hours)	28,365	23,350
Cost Burden (Dollars)	255,947	0

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Abstract: This generic clearance request encompasses general questionnaire development, pre-testing, measurement-error reduction activities to be carried out in 2021-2024 in the Division of Research and Methodology, National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC). The revision request consists of an increase in burden hours for the next 3-year approval period. The difference is due to an anticipated increase in the number and size of projects being undertaken.

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Authorizing Statute(s): US Code: 42 USC 242k Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 28357	05/26/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 44728	08/13/2021
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 0

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ICR Summary of Burden

table that charts list of burden

	Total Request	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	66,375	56,100	0	10,275	0	0
Annual Time Burden (Hours)	28,365	23,350	0	5,015	0	0
Annual Cost Burden (Dollars)	255,947	0	0	255,947	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The increase in burden hours is due to an anticipated increase in the number and size of projects being undertaken. The increase in burden cost is an administrative correction. Burden cost was omitted from the previous submission in ROCIS.

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Annual Cost to Federal Government: $3,178,325

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/16/2021

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