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[nchs] Ccqder - Nisvs
[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research
OMB: 0920-0222
IC ID: 263924
OMB.report
HHS/CDC
OMB 0920-0222
ICR 202504-0920-019
IC 263924
( )
Documents and Forms
Document Name
Document Type
Form 0920-0222
[NCHS] CCQDER - NISVS
Form and Instruction
0920-0222 NISVS Screener
Attachment 4_Screener_NISVS TBI.docx
Form and Instruction
0920-0222 NISVS Questionnaire
Attachment 1_Questions to test.docx
Form and Instruction
0920-0222 {NISVS] Respondent Data Collection Sheet (No Form)
Respondent Data Collection Sheet - NISVS.docx
Form
Attachment 2- Previous Use and Development.docx
NISVS - Previous Use and Development
IC Document
Attachment 3- Advertisement_NISVS TBI.docx
NISVS/TBI - Advertisement
IC Document
Attachment 5_Informed Consent_NISVS TBI 12.5.23.docx
NISVS/TBI - Informed Consent
IC Document
Attachment 6 -Respondent Distress guide.docx
NISVS/TBI - Respondent Distress Guide
IC Document
Attachment 7-Interviewer Distress Guidance_.docx
NISVS/TBI - Interviewer Distress Guide
IC Document
Attachment 8-Secondary Trauma Training by Gordon Hughes (1).pdf
NISVS/TBI - Secondary Trauma Training
IC Document
Supporting Statement A_NISVS TBI 12.8.23.docx
09s0-0222 GenIC Request Template / SSA
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
[NCHS] CCQDER - NISVS
Agency IC Tracking Number:
0920-0222-24BR
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
NISVS Screener
Attachment 4_Screener_NISVS TBI.docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0222
NISVS Questionnaire
Attachment 1_Questions to test.docx
NA
No
Paper Only
Form
0920-0222
{NISVS] Respondent Data Collection Sheet (No Form)
Respondent Data Collection Sheet - NISVS.docx
NA
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
Health and Demographic Surveys Conducted in Probability Samples of the U. S. Population 09-20-0164
FR Citation:
49 FR 37693
Number of Respondents:
80
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
80
0
0
0
0
80
Annual IC Time Burden (Hours)
23
0
0
0
0
23
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
NISVS - Previous Use and Development
Attachment 2- Previous Use and Development.docx
12/19/2023
NISVS/TBI - Advertisement
Attachment 3- Advertisement_NISVS TBI.docx
12/19/2023
NISVS/TBI - Informed Consent
Attachment 5_Informed Consent_NISVS TBI 12.5.23.docx
12/19/2023
NISVS/TBI - Respondent Distress Guide
Attachment 6 -Respondent Distress guide.docx
12/19/2023
NISVS/TBI - Interviewer Distress Guide
Attachment 7-Interviewer Distress Guidance_.docx
12/19/2023
NISVS/TBI - Secondary Trauma Training
Attachment 8-Secondary Trauma Training by Gordon Hughes (1).pdf
12/19/2023
09s0-0222 GenIC Request Template / SSA
Supporting Statement A_NISVS TBI 12.8.23.docx
12/19/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.