Information Collection

[NCHS] Collaborating Center For Questionnaire Design and Evaluation Research

IC 259654 under ICR 202212-0920-003 · OMB 0920-0222.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0222-23EC [NCHS] Collaborating Center For Questionnaire Design and Evaluation Research	Form and Instruction
0920-0222-23EC RANDS 8 Questionnaire Attachment 1 -RANDS 8 Questionnaire.docx	Form and Instruction
Attachment 2- Advertisement.docx Attachment 2- Advertisement	IC Document
Attachment 3- Screening Script.docx Attachment 3- Screening Script	IC Document
Attachment 4 - Informed Consent.docx Attachment 4 - Informed Consent	IC Document
Attachment 5- Thank You Letter.docx Attachment 5- Thank You Letter	IC Document
Attachment 6-Data Retention Policy.docx Attachment 6-Data Retention Policy	IC Document
Attachment 7 - NCHS Non-Disclosure Affidavit.docx Attachment 7 - NCHS Non-Disclosure Affidavit	IC Document
Attachment 8 - NORC CIPESA Protection Plan.docx Attachment 8 - NORC CIPESA Protection Plan	IC Document
SSA- RANDS 8.docx SSA- RANDS 8	IC Document
SSB- RANDS 8.docx SSB- RANDS 8	IC Document

IC Title:

[NCHS] Collaborating Center For Questionnaire Design and Evaluation Research

Agency IC Tracking Number:

0920-0222-23EC

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0222-23EC	RANDS 8 Questionnaire	Attachment 1 -RANDS 8 Questionnaire.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 16,600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	16,600	16,600
Annual IC Time Burden (Hours)	4,150	4,150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 2- Advertisement	Attachment 2- Advertisement.docx	04/12/2023
Attachment 3- Screening Script	Attachment 3- Screening Script.docx	04/12/2023
Attachment 4 - Informed Consent	Attachment 4 - Informed Consent.docx	04/12/2023
Attachment 5- Thank You Letter	Attachment 5- Thank You Letter.docx	04/12/2023
Attachment 6-Data Retention Policy	Attachment 6-Data Retention Policy.docx	04/12/2023
Attachment 7 - NCHS Non-Disclosure Affidavit	Attachment 7 - NCHS Non-Disclosure Affidavit.docx	04/12/2023
Attachment 8 - NORC CIPESA Protection Plan	Attachment 8 - NORC CIPESA Protection Plan.docx	04/12/2023
SSA- RANDS 8	SSA- RANDS 8.docx	04/12/2023
SSB- RANDS 8	SSB- RANDS 8.docx	04/12/2023

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