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[NCHS] RANDS 10 and Accompanying Cognitive Interviews (24CL)
[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research
OMB: 0920-0222
IC ID: 264723
OMB.report
HHS/CDC
OMB 0920-0222
ICR 202504-0920-019
IC 264723
( )
Documents and Forms
Document Name
Document Type
Form 0920-0222
[NCHS] RANDS 10 and Accompanying Cognitive Interviews (24CL)
Form
Attachment 1b. Proposed RANDS 10 Questionnaire.docx
Other-Proposed Questions
0920-0222 CCQDER RANDS 10 Questionnaire
Attachment 1a Questions for Cognitive Interviews Whole Person Health.docx
Form
0920-022 (24CL) Telephone Screening Script
Attachment 4 Screening Script Whole Person Health 1.9.24.docx
Form
0920-0222 (24CL) Respondent Data Collection Sheet
Attachment 9 Data Collection Sheet.docx
Form and Instruction
Supporting Statement A - Whole Person Health RANDS 10-1.29.24.docx
SSA (24CL)
IC Document
Attachment 2 Previous Use and Development.docx
Previous use and Development
IC Document
Attachment 3 Advertisement Template Whole Person Health.docx
Participants Wanted for Research Study (Advertisement/Flyer)
IC Document
Attachment 5 Informed Consent Whole Person Health 1.9.24.docx
Adult Informed Consent for Interviews (face-to-face)
IC Document
Attachment 6 NCHS Non-Disclosure Affidavit for NORC.docx
NCHS Non-Disclosure Affidavit for NORC Organization Staff working on RANDS
IC Document
Attachment 7 Data Retention Policy.docx
CCQDER Data Storage and Access Policy
IC Document
Attachment 8 Thank You Letter.docx
Thank You Letter
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
[NCHS] RANDS 10 and Accompanying Cognitive Interviews (24CL)
Agency IC Tracking Number:
0920-0222-24CL
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
0920-0222
CCQDER RANDS 10 Questionnaire
Attachment 1a Questions for Cognitive Interviews Whole Person Health.docx
Yes
Yes
Fillable Fileable
Other-Proposed Questions
Attachment 1b. Proposed RANDS 10 Questionnaire.docx
No
Paper Only
Form
0920-022 (24CL)
Telephone Screening Script
Attachment 4 Screening Script Whole Person Health 1.9.24.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0222 (24CL)
Respondent Data Collection Sheet
Attachment 9 Data Collection Sheet.docx
No
Fillable Fileable
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 US Population 09-20-0164
FR Citation:
49 FR 37693
Number of Respondents:
6,720
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
6,720
0
0
0
0
6,720
Annual IC Time Burden (Hours)
2,290
0
0
0
0
2,290
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SSA (24CL)
Supporting Statement A - Whole Person Health RANDS 10-1.29.24.docx
01/30/2024
Previous use and Development
Attachment 2 Previous Use and Development.docx
01/26/2024
Participants Wanted for Research Study (Advertisement/Flyer)
Attachment 3 Advertisement Template Whole Person Health.docx
01/26/2024
Adult Informed Consent for Interviews (face-to-face)
Attachment 5 Informed Consent Whole Person Health 1.9.24.docx
01/26/2024
NCHS Non-Disclosure Affidavit for NORC Organization Staff working on RANDS
Attachment 6 NCHS Non-Disclosure Affidavit for NORC.docx
01/26/2024
CCQDER Data Storage and Access Policy
Attachment 7 Data Retention Policy.docx
01/26/2024
Thank You Letter
Attachment 8 Thank You Letter.docx
01/26/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.