OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

[NCHS] Direct Care Worker Pilot Study

IC 260303 under ICR 202212-0920-005 · OMB 0920-1030.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

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[NCHS] Direct Care Worker Pilot Study 0920-1030-23FI
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Director Sampling Appointment Setting Call Att B-1 Director Sampling Appointment Setting Call 5.11.23_final.docx No   Fillable Fileable
Form and Instruction n/a Director DCS Sampling Call Att B-3 Director DCW Sampling Call 5.11.23_final.docx No   Fillable Fileable
Form and Instruction n/a DCW Draft Question List Att C DCW draft question List 5.11.23_final.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

Health Resources Utilization Statistics  59 FR 48331

1,440 0
   
Individuals or Households
 
   40 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,440 0 1,440 0 0 0
Annual IC Time Burden (Hours) 480 0 480 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Director Mailing Cover Letter with FAQs Att A-1 Director mailing NCHS Cover Letter with FAQs 5.17.23.docx 05/22/2023
DCW Mailing Cover Letter with FAQs Att A-2 DCW NCHS Cover Letter with FAQs 5.17.23.docx 05/22/2023
Strictly Confidential Brochure Att A-3 NCHS Strictly Confidential Brochure 5.11.23.docx 05/22/2023
CATI Confirmation and Prep Letter/Email Att B-2 CATI Confirmation and Prep Letter or email.docx 05/22/2023
Thank You Reminder Letters Att D-1 Thank You Reminder letters 5.17.23.docx 05/22/2023
Prompting Letters Att D-2 Prompting emails 5.17.23.docx 05/22/2023
Human Subjects Determination Att E Human Subjects Determination 5.17.23.docx 05/22/2023
SSA NPALS DCW Pilot Supp State A_5.16.23_final.docx 05/22/2023
SSB NPALS DCW Pilot Supp State B_5.16.23.docx 05/22/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.