Information Collection Request

[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research

ICR 202504-0920-019 · OMB 0920-0222 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
RANDS 12 Questionnaire Form and Instruction New Available
Questions to be Cognitively Tested Form and Instruction New Available
Data Collection Sheet Form and Instruction New Repair queued
Screening Script Form and Instruction New Repair queued
Respondent Data Collection Sheet Form and Instruction New Repair queued
Questions to be Cognitively Tested Form and Instruction New Available
Screening Script Form and Instruction New Available
Form 0920-0222 (25BG) Cognitive Interviewing Telephone Screening Script Form and Instruction Unchanged Available
Form 0920-0222 (25BG) Respondent Data Collection Sheet Form and Instruction Unchanged Available
Form 0920-0222 (25BG) Focus Group Telephone Screening Script Form and Instruction Unchanged Available
Form 0920-0222 (25BG) Focus Grouip Protocol Form and Instruction Unchanged Available
Form 0920-0222 (25BG) [NCHS] 2024 NHIS Diabetes Form and Instruction Unchanged Missing upstream
RANDS 11 Questionnaire-12.10.2024 Form and Instruction Modified Available
[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research - RANDS 11 Form and Instruction Modified Repair queued
Form 0920-24IT Respondent Informed Consent Form Unchanged Available
Form 0920-24IT Respondent Data Collection Form Unchanged Repair queued
Form 0920-24IT [NCHS] BMI Focus Groups Form Unchanged Repair queued
Form 0920-0222 Respondent Data Collection Sheet Form and Instruction Unchanged Available
Form 0920-0222 Questions to be Cognitively Tested Form and Instruction Unchanged Available
Form 0920-0222 Cognitive Decline - Screening Script Form and Instruction Unchanged Available
Form 0920-0222 CCQDER - Questions on Subjective Cognitive Decline Form and Instruction Unchanged Repair queued
Form 0920-0222 Attachment 5 Informed Consent ADHD Form and Instruction Unchanged Available
Form 0920-0222 ADHD Attachment 1 Questions to be tested Form and Instruction Unchanged Available
Form 0920-0222 Attachment 6 Respondent Data Collection Sheet Form and Instruction Unchanged Repair queued
Form 0920-0222 [NCHS] genIC Attention Deficient Hyperactivity Disorder Questions Form and Instruction Unchanged Repair queued
Data Collection Sheets Form and Instruction Unchanged Available
Interviewer's Guide Form and Instruction Unchanged Available
Telephone Screening Script Form and Instruction Unchanged Available
[NCHS] Point of Care Checklist Subproject 1: Conducting In-depth Interviews Among Those with Intellectual and Developmental Disabilities Form and Instruction Unchanged Repair queued
Cannabis Data Collection Sheet Form and Instruction Unchanged Available
Cannabis Screening Script Form and Instruction Unchanged Available
Cannabis Questions to be Cognitively Tested Form and Instruction Unchanged Available
[NCHS] Evaluation of Revised Questions on Cannabis Use and Experiences Form and Instruction Unchanged Repair queued
Form 0920-0222 (24CL) Respondent Data Collection Sheet Form and Instruction Unchanged Available
Form 0920-022 (24CL) Telephone Screening Script Form Unchanged Available
Form 0920-0222 CCQDER RANDS 10 Questionnaire Form Unchanged Available
Form 0920-0222 [NCHS] RANDS 10 and Accompanying Cognitive Interviews (24CL) Form Unchanged Repair queued
Form 0920-24BI Attachment 3a- NHANES English Advertisement Form and Instruction Unchanged Available
Form 0920-24BI Attachment 5a & 5b - Informed Consent NHANES 11.16.23 Form and Instruction Unchanged Available
Form 0920-24BI Attachment 4b- Screening script NHANES 11.16.23 CLEAN Form and Instruction Unchanged Available
Form 0920-24BI Attachment 4a - Screening script NHANES 11.16.23 CLEAN Form and Instruction Unchanged Available
Form 0920-24BI Attachment 1b-NHANES Question Set 2 11.22.23 CLEAN Form and Instruction Unchanged Available
Form 0920-24BI Attachment 1a-NHANES Question Set 1 11.16.23 CLEAN Form and Instruction Unchanged Available
Form 0920-24BI [NCHS]CCQDER's NHANES Feeding Practices Form and Instruction Unchanged Missing upstream
Form 0920-0222 {NISVS] Respondent Data Collection Sheet (No Form) Form Unchanged Repair queued
Form 0920-0222 NISVS Questionnaire Form and Instruction Unchanged Available
Form 0920-0222 NISVS Screener Form and Instruction Unchanged Available
Form 0920-0222 [NCHS] CCQDER - NISVS Form and Instruction Unchanged Missing upstream
Form 1 qustionnaire Form and Instruction Unchanged Available
Form 1 GenIC for CCQDER's RANDS 9 Form and Instruction Unchanged Missing upstream
Form 0920-0222-23EQ Screening Script Form and Instruction Unchanged Available
Form 0920- 0222-23EQ Questions Form and Instruction Unchanged Available
Form 0920-0222-23EQ Attachment 5a-5b Respondent Data Collection Sheet 4.28.23 Form and Instruction Unchanged Available
Form 0920-0222-23EQ [NCHS] COLLABORATING CENTER FOR QUESTIONNAIRE DESIGN AND EVALUATION RESEARCH Form and Instruction Unchanged Repair queued
Respondent Data Collection Sheet Form and Instruction Unchanged Available
Caregiving Screening Script Form and Instruction Unchanged Available
Caregiving Questions Form and Instruction Unchanged Available
[NCHS] CCQDER's Caregiver Form and Instruction Unchanged Repair queued
Form 0920-0222-23EC RANDS 8 Questionnaire Form and Instruction Unchanged Available
Form 0920-0222-23EC [NCHS] Collaborating Center For Questionnaire Design and Evaluation Research Form and Instruction Unchanged Repair queued
Change Request Memo - EO14168 - 0920-0222 (RANDS 11).docx Justification for No Material/Nonsubstantive Change Uploaded 2025-04-22 Repair queued
Change Request Memo - EO14168 - 0920-0222 (RANDS 11).docx Justification for No Material/Nonsubstantive Change Uploaded 2025-04-22 Missing upstream
Att B 60-Day Published FRN 9_30_2022.pdf Supplementary Document Uploaded 2022-12-14 Available
Att B 60-Day Published FRN 9_30_2022.pdf Supplementary Document Uploaded 2022-12-14 Repair queued
SSB_0222_12012022.docx Supporting Statement B Uploaded 2022-12-02 Available
SSB_0222_12012022.docx Supporting Statement B Uploaded 2022-12-02 Missing upstream
SSA_0222-12012022.docx Supporting Statement A Uploaded 2022-12-02 Repair queued
SSA_0222-12012022.docx Supporting Statement A Uploaded 2022-12-02 Repair queued
Att O Thank You Letter.docx Supplementary Document Uploaded 2021-08-03 Repair queued
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 Available
Att N Explain Cog Interview.docx Supplementary Document Uploaded 2021-08-03 Repair queued
Att M Sample Resp Data Collect Sheet.docx Supplementary Document Uploaded 2021-08-03 Repair queued
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 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 Available
Att K Voice mail script.docx Supplementary Document Uploaded 2021-08-03 Missing upstream
Att J Sample newspaper adv.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 Available
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 Available
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 G Spec Consent Focus Group.docx Supplementary Document Uploaded 2021-08-03 Missing upstream
Att F Spec Consent Cog Int.docx Supplementary Document Uploaded 2021-08-03 Available
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 Available
Att E Informed Consent.docx Supplementary Document Uploaded 2021-08-03 Available
Att D Screening Script.docx Supplementary Document Uploaded 2021-08-03 Available
Att D Screening Script.docx Supplementary Document Uploaded 2021-08-03 Repair queued
Att C Nondisclosure Affidavit.docx Supplementary Document Uploaded 2021-08-03 Repair queued
Att C Nondisclosure Affidavit.docx Supplementary Document Uploaded 2021-08-03 Available
Att A Public Health Serv Act.docx Supplementary Document Uploaded 2021-08-03 Available
Att A Public Health Serv Act.docx Supplementary Document Uploaded 2021-08-03 Available
IC Document Collections
IC IDCollectionTypeStatusForm
277332 [HCHS] Cognitive Evaluation of Questions on Overdose and Substance Use Disorder and RANDS 12 Form and Instruction NewRANDS 12 Questionnaire
277332 [HCHS] Cognitive Evaluation of Questions on Overdose and Substance Use Disorder and RANDS 12 Form and Instruction NewQuestions to be Cognitively Tested
277332 [HCHS] Cognitive Evaluation of Questions on Overdose and Substance Use Disorder and RANDS 12 Form and Instruction NewData Collection Sheet
277332 [HCHS] Cognitive Evaluation of Questions on Overdose and Substance Use Disorder and RANDS 12 Form and Instruction NewScreening Script
276212 [NCHS] CCQDER - Questions to Identify People with Intellectual and Developmental Disabilities at Point-of-Care Settings Form and Instruction NewRespondent Data Collection Sheet
276212 [NCHS] CCQDER - Questions to Identify People with Intellectual and Developmental Disabilities at Point-of-Care Settings Form and Instruction NewQuestions to be Cognitively Tested
276212 [NCHS] CCQDER - Questions to Identify People with Intellectual and Developmental Disabilities at Point-of-Care Settings Form and Instruction NewScreening Script
272342 [NCHS] 2024 NHIS Diabetes Form and Instruction UnchangedCognitive Interviewing Telephone Screening Script
272342 [NCHS] 2024 NHIS Diabetes Form and Instruction UnchangedRespondent Data Collection Sheet
272342 [NCHS] 2024 NHIS Diabetes Form and Instruction UnchangedFocus Group Telephone Screening Script
272342 [NCHS] 2024 NHIS Diabetes Form and Instruction UnchangedFocus Grouip Protocol
272342 [NCHS] 2024 NHIS Diabetes Form and Instruction Unchanged
272296 [NCHS] Collaborating Center for Questionnaire Design and Evaluation Research - RANDS 11 Form and Instruction ModifiedRANDS 11 Questionnaire-12.10.2024
272296 [NCHS] Collaborating Center for Questionnaire Design and Evaluation Research - RANDS 11 Form and Instruction Modified
271058 [NCHS] BMI Focus Groups Form UnchangedRespondent Informed Consent
271058 [NCHS] BMI Focus Groups Form UnchangedRespondent Data Collection
271058 [NCHS] BMI Focus Groups Form Unchanged
269389 CCQDER - Questions on Subjective Cognitive Decline Form and Instruction UnchangedRespondent Data Collection Sheet
269389 CCQDER - Questions on Subjective Cognitive Decline Form and Instruction UnchangedQuestions to be Cognitively Tested
269389 CCQDER - Questions on Subjective Cognitive Decline Form and Instruction UnchangedCognitive Decline - Screening Script
269389 CCQDER - Questions on Subjective Cognitive Decline Form and Instruction Unchanged
266008 [NCHS] genIC Attention Deficient Hyperactivity Disorder Questions Form and Instruction UnchangedAttachment 5 Informed Consent ADHD
266008 [NCHS] genIC Attention Deficient Hyperactivity Disorder Questions Form and Instruction UnchangedADHD Attachment 1 Questions to be tested
266008 [NCHS] genIC Attention Deficient Hyperactivity Disorder Questions Form and Instruction UnchangedAttachment 6 Respondent Data Collection Sheet
266008 [NCHS] genIC Attention Deficient Hyperactivity Disorder Questions Form and Instruction Unchanged
265792 [NCHS] Point of Care Checklist Subproject 1: Conducting In-depth Interviews Among Those with Intellectual and Developmental Disabilities Form and Instruction UnchangedData Collection Sheets
265792 [NCHS] Point of Care Checklist Subproject 1: Conducting In-depth Interviews Among Those with Intellectual and Developmental Disabilities Form and Instruction UnchangedInterviewer's Guide
265792 [NCHS] Point of Care Checklist Subproject 1: Conducting In-depth Interviews Among Those with Intellectual and Developmental Disabilities Form and Instruction UnchangedTelephone Screening Script
265792 [NCHS] Point of Care Checklist Subproject 1: Conducting In-depth Interviews Among Those with Intellectual and Developmental Disabilities Form and Instruction Unchanged
264921 [NCHS] Evaluation of Revised Questions on Cannabis Use and Experiences Form and Instruction UnchangedCannabis Data Collection Sheet
264921 [NCHS] Evaluation of Revised Questions on Cannabis Use and Experiences Form and Instruction UnchangedCannabis Screening Script
264921 [NCHS] Evaluation of Revised Questions on Cannabis Use and Experiences Form and Instruction UnchangedCannabis Questions to be Cognitively Tested
264921 [NCHS] Evaluation of Revised Questions on Cannabis Use and Experiences Form and Instruction Unchanged
264723 [NCHS] RANDS 10 and Accompanying Cognitive Interviews (24CL) Form and Instruction UnchangedRespondent Data Collection Sheet
264723 [NCHS] RANDS 10 and Accompanying Cognitive Interviews (24CL) Form UnchangedTelephone Screening Script
264723 [NCHS] RANDS 10 and Accompanying Cognitive Interviews (24CL) Form UnchangedCCQDER RANDS 10 Questionnaire
264723 [NCHS] RANDS 10 and Accompanying Cognitive Interviews (24CL) Form Unchanged
264723 [NCHS] RANDS 10 and Accompanying Cognitive Interviews (24CL) Other-Proposed Questions Unchanged
264394 [NCHS]CCQDER's NHANES Feeding Practices Form and Instruction UnchangedAttachment 3a- NHANES English Advertisement
264394 [NCHS]CCQDER's NHANES Feeding Practices Form and Instruction UnchangedAttachment 5a & 5b - Informed Consent NHANES 11.16.23
264394 [NCHS]CCQDER's NHANES Feeding Practices Form and Instruction UnchangedAttachment 4b- Screening script NHANES 11.16.23 CLEAN
264394 [NCHS]CCQDER's NHANES Feeding Practices Form and Instruction UnchangedAttachment 4a - Screening script NHANES 11.16.23 CLEAN
264394 [NCHS]CCQDER's NHANES Feeding Practices Form and Instruction UnchangedAttachment 1b-NHANES Question Set 2 11.22.23 CLEAN
264394 [NCHS]CCQDER's NHANES Feeding Practices Form and Instruction UnchangedAttachment 1a-NHANES Question Set 1 11.16.23 CLEAN
264394 [NCHS]CCQDER's NHANES Feeding Practices Form and Instruction Unchanged
263924 [NCHS] CCQDER - NISVS Form Unchanged{NISVS] Respondent Data Collection Sheet (No Form)
263924 [NCHS] CCQDER - NISVS Form and Instruction UnchangedNISVS Questionnaire
263924 [NCHS] CCQDER - NISVS Form and Instruction UnchangedNISVS Screener
263924 [NCHS] CCQDER - NISVS Form and Instruction Unchanged
262818 GenIC for CCQDER's RANDS 9 Form and Instruction Unchangedqustionnaire
262818 GenIC for CCQDER's RANDS 9 Form and Instruction Unchanged
260045 [NCHS] COLLABORATING CENTER FOR QUESTIONNAIRE DESIGN AND EVALUATION RESEARCH Form and Instruction UnchangedScreening Script
260045 [NCHS] COLLABORATING CENTER FOR QUESTIONNAIRE DESIGN AND EVALUATION RESEARCH Form and Instruction UnchangedQuestions
260045 [NCHS] COLLABORATING CENTER FOR QUESTIONNAIRE DESIGN AND EVALUATION RESEARCH Form and Instruction UnchangedAttachment 5a-5b Respondent Data Collection Sheet 4.28.23
260045 [NCHS] COLLABORATING CENTER FOR QUESTIONNAIRE DESIGN AND EVALUATION RESEARCH Form and Instruction Unchanged
260017 [NCHS] CCQDER's Caregiver Form and Instruction UnchangedRespondent Data Collection Sheet
260017 [NCHS] CCQDER's Caregiver Form and Instruction UnchangedCaregiving Screening Script
260017 [NCHS] CCQDER's Caregiver Form and Instruction UnchangedCaregiving Questions
260017 [NCHS] CCQDER's Caregiver Form and Instruction Unchanged
259654 [NCHS] Collaborating Center For Questionnaire Design and Evaluation Research Form and Instruction UnchangedRANDS 8 Questionnaire
259654 [NCHS] Collaborating Center For Questionnaire Design and Evaluation Research Form and Instruction Unchanged
ICR Details
0920-0222 202504-0920-019
Historical Active 202212-0920-003
HHS/CDC 0920-25-0099
[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved with change 07/03/2025
Retrieve Notice of Action (NOA) 05/01/2025
  Inventory as of this Action Requested Previously Approved
01/31/2026 01/31/2026 01/31/2026
215,775 0 215,775
65,715 0 65,715
1,840,677 0 1,840,677

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 change request is for RANDS 11 to adhere to recent executive orders.

US Code: 42 USC 242k Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  87 FR 59425 09/30/2022
87 FR 76049 12/12/2022
No

16
IC Title Form No. Form Name
CCQDER - Questions on Subjective Cognitive Decline 0920-0222, 0920-0222, 0920-0222 Cognitive Decline - Screening Script ,   Questions to be Cognitively Tested ,   Respondent Data Collection Sheet
GenIC for CCQDER's RANDS 9 1 qustionnaire
[HCHS] Cognitive Evaluation of Questions on Overdose and Substance Use Disorder and RANDS 12 n/a, n/a, n/a, n/a Screening Script ,   Data Collection Sheet ,   Questions to be Cognitively Tested ,   RANDS 12 Questionnaire
[NCHS] 2024 NHIS Diabetes 0920-0222 (25BG), 0920-0222 (25BG), 0920-0222 (25BG), 0920-0222 (25BG) Focus Grouip Protocol ,   Focus Group Telephone Screening Script ,   Respondent Data Collection Sheet ,   Cognitive Interviewing Telephone Screening Script
[NCHS] BMI Focus Groups 0920-24IT, 0920-24IT Respondent Data Collection ,   Respondent Informed Consent
[NCHS] CCQDER - NISVS 0920-0222, 0920-0222, 0920-0222 NISVS Screener ,   NISVS Questionnaire ,   {NISVS] Respondent Data Collection Sheet (No Form)
[NCHS] CCQDER - Questions to Identify People with Intellectual and Developmental Disabilities at Point-of-Care Settings n/a, n/a, n/a Screening Script ,   Questions to be Cognitively Tested ,   Respondent Data Collection Sheet
[NCHS] CCQDER's Caregiver n/a, n/a, n/a Caregiving Questions ,   Caregiving Screening Script ,   Respondent Data Collection Sheet
[NCHS] COLLABORATING CENTER FOR QUESTIONNAIRE DESIGN AND EVALUATION RESEARCH 0920-0222-23EQ, 0920- 0222-23EQ, 0920-0222-23EQ Attachment 5a-5b Respondent Data Collection Sheet 4.28.23 ,   Questions ,   Screening Script
[NCHS] Collaborating Center For Questionnaire Design and Evaluation Research 0920-0222-23EC RANDS 8 Questionnaire
[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research - RANDS 11 n/a RANDS 11 Questionnaire-12.10.2024
[NCHS] Evaluation of Revised Questions on Cannabis Use and Experiences n/a, n/a, n/a Cannabis Questions to be Cognitively Tested ,   Cannabis Screening Script ,   Cannabis Data Collection Sheet
[NCHS] Point of Care Checklist Subproject 1: Conducting In-depth Interviews Among Those with Intellectual and Developmental Disabilities n/a, n/a, n/a Telephone Screening Script ,   Interviewer's Guide ,   Data Collection Sheets
[NCHS] RANDS 10 and Accompanying Cognitive Interviews (24CL) 0920-0222, 0920-022 (24CL), 0920-0222 (24CL) CCQDER RANDS 10 Questionnaire ,   Telephone Screening Script ,   Respondent Data Collection Sheet
[NCHS] genIC Attention Deficient Hyperactivity Disorder Questions 0920-0222, 0920-0222, 0920-0222 Attachment 6 Respondent Data Collection Sheet ,   ADHD Attachment 1 Questions to be tested ,   Attachment 5 Informed Consent ADHD
[NCHS]CCQDER's NHANES Feeding Practices 0920-24BI, 0920-24BI, 0920-24BI, 0920-24BI, 0920-24BI, 0920-24BI Attachment 1a-NHANES Question Set 1 11.16.23 CLEAN ,   Attachment 1b-NHANES Question Set 2 11.22.23 CLEAN ,   Attachment 4a - Screening script NHANES 11.16.23 CLEAN ,   Attachment 4b- Screening script NHANES 11.16.23 CLEAN ,   Attachment 5a & 5b - Informed Consent NHANES 11.16.23 ,   Attachment 3a- NHANES English Advertisement

  Total Approved 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 215,775 215,775 0 0 0 0
Annual Time Burden (Hours) 65,715 65,715 0 0 0 0
Annual Cost Burden (Dollars) 1,840,677 1,840,677 0 0 0 0
No
No
Revision for 0920-0222 requests an increase in burden hours for the next 3-year approval period due to an anticipated increase in the number of RANDS Methodological projects during the approval period.

$3,223,325
Yes Part B of Supporting Statement
    Yes
    Yes
No
No
No
No
Kevin Joyce 404 639-1944 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
05/01/2025