Information Collection

[NCHS] RANDS 10 and Accompanying Cognitive Interviews (24CL)

IC 264723 under ICR 202504-0920-019 · OMB 0920-0222.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:

2026-07-06 - Reinstatement without change of a previously approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0222 [NCHS] RANDS 10 and Accompanying Cognitive Interviews (24CL)	Form
Form 0920-0222 CCQDER RANDS 10 Questionnaire [NCHS] RANDS 10 and Accompanying Cognitive Interviews (24CL)	Form
Form 0920-022 (24CL) Telephone Screening Script [NCHS] RANDS 10 and Accompanying Cognitive Interviews (24CL)	Form
Form 0920-0222 (24CL) Respondent Data Collection Sheet [NCHS] RANDS 10 and Accompanying Cognitive Interviews (24CL)	Form and Instruction
Attachment 1b. Proposed RANDS 10 Questionnaire.docx	Other-Proposed Questions
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
0920-0222 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
0920-022 (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
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
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 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 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 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 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 7 Data Retention Policy.docx CCQDER Data Storage and Access Policy	IC Document
Attachment 8 Thank You Letter.docx Thank You Letter	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:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-0222	Yes	Yes	Fillable Fileable
Other-Proposed Questions		No		Paper Only
Form	0920-022 (24CL)	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0222 (24CL)	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 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	6,720	6,720
Annual IC Time Burden (Hours)	2,290	2,290
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA (24CL)		01/30/2024
Previous use and Development		01/26/2024
Participants Wanted for Research Study (Advertisement/Flyer)		01/26/2024
Adult Informed Consent for Interviews (face-to-face)		01/26/2024
NCHS Non-Disclosure Affidavit for NORC Organization Staff working on RANDS		01/26/2024
CCQDER Data Storage and Access Policy		01/26/2024
Thank You Letter		01/26/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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