Information Collection

Interviews Observation Form (Screener Verification)

IC 216268 under ICR 202404-0920-003 · OMB 0920-0314.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0314 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0314 Interviews Observation Form (Screener Verification)	Form and Instruction
Form 0920-0314 Interviews Observation Form (Screener Verification)	Form and Instruction
0920-0314 INTERVIEW OBSERVATION FORM ATT-L-InterviewObsForm_revJun2021.docx	Form and Instruction
0920-0314 INTERVIEW OBSERVATION FORM ATT-L-InterviewObsForm_revJun2021.docx	Form and Instruction
ATT-K-NSFG-VerificationProcedures.docx In-person Interview Verification Procedures and Questionnaires for Screener Survey and Main Survey	IC Document
ATT-K-NSFG-VerificationProcedures.docx In-person Interview Verification Procedures and Questionnaires for Screener Survey and Main Survey	IC Document

IC Title:

Interviews Observation Form (Screener Verification)

Agency IC Tracking Number:

0920-0314

Is this a Common Form? No

IC Status: Unchanged

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	0920-0314	INTERVIEW OBSERVATION FORM	ATT-L-InterviewObsForm_revJun2021.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population

FR Citation: 49 FR 37693

Number of Respondents: 250

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	Previously Approved
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
In-person Interview Verification Procedures and Questionnaires for Screener Survey and Main Survey	ATT-K-NSFG-VerificationProcedures.docx	07/28/2023

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