Information Collection

[NCHS] Collaborating Center For Questionnaire Design and Evaluation Research

IC 259654 under ICR 202504-0920-019 · OMB 0920-0222.

Documents and Forms

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
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 2- Advertisement.docx Attachment 2- Advertisement IC Document
Attachment 3- Screening Script.docx Attachment 3- Screening Script 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 4 - Informed Consent.docx Attachment 4 - Informed Consent IC Document
Attachment 5- Thank You Letter.docx Attachment 5- Thank You Letter 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 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 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
Attachment 8 - NORC CIPESA Protection Plan.docx Attachment 8 - NORC CIPESA Protection Plan IC Document
SSA- RANDS 8.docx SSA- RANDS 8 IC Document
SSA- RANDS 8.docx SSA- RANDS 8 IC Document
SSB- RANDS 8.docx SSB- RANDS 8 IC Document
SSB- RANDS 8.docx SSB- RANDS 8 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	[NCHS] Collaborating Center For Questionnaire Design and Evaluation Research	Agency IC Tracking Number:	0920-0222-23EC

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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

Federal Enterprise Architecture Business Reference Module

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 %

	Requested	Previously Approved
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

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.