[nchs] Ccqder - Nisvs

[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research

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

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

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	Previously Approved
Annual Number of Responses for this IC	80	80
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	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.