Information Collection

[NCHS] Evaluation of Revised Questions on Cannabis Use and Experiences

IC 264921 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⚠️ Notice: This information collection may be referencing outdated material.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
[NCHS] Evaluation of Revised Questions on Cannabis Use and Experiences	Form and Instruction
Cannabis Questions to be Cognitively Tested [NCHS] Evaluation of Revised Questions on Cannabis Use and Experiences	Form and Instruction
Cannabis Screening Script [NCHS] Evaluation of Revised Questions on Cannabis Use and Experiences	Form and Instruction
Cannabis Data Collection Sheet [NCHS] Evaluation of Revised Questions on Cannabis Use and Experiences	Form and Instruction
Cannabis Questions to be Cognitively Tested Attachment 1- Cannabis Questions.docx	Form and Instruction
Cannabis Questions to be Cognitively Tested Attachment 1- Cannabis Questions.docx	Form and Instruction
Cannabis Screening Script Attachment 4 - Cannabis Screening Script- Clean 1.9.24.docx	Form and Instruction
Cannabis Screening Script Attachment 4 - Cannabis Screening Script- Clean 1.9.24.docx	Form and Instruction
Cannabis Data Collection Sheet Attachment 6- Cannabis Data Collection Sheet.docx	Form and Instruction
Cannabis Data Collection Sheet Attachment 6- Cannabis Data Collection Sheet.docx	Form and Instruction
SSA-Cannabis-2024-Streamline-1.30.24_final.docx SSA	IC Document
SSA-Cannabis-2024-Streamline-1.30.24_final.docx SSA	IC Document
Attachment 2 - Question Provenance.docx Question Provenance	IC Document
Attachment 2 - Question Provenance.docx Question Provenance	IC Document
Attachment 3- Cannabis Advertisement.docx Cannabis Advertisment	IC Document
Attachment 3- Cannabis Advertisement.docx Cannabis Advertisment	IC Document
Attachment 5 - Cannabis Informed Consent- CLEAN 1.5.24.docx Informed Consent	IC Document
Attachment 5 - Cannabis Informed Consent- CLEAN 1.5.24.docx Informed Consent	IC Document
Attachment 7- Thank You Letter.docx Thank You Letter	IC Document
Attachment 7- Thank You Letter.docx Thank You Letter	IC Document
Attachment 8- NCHS Non-Disclosure Affidavit.docx NCHS Non-Disclosure Affidavit	IC Document
Attachment 8- NCHS Non-Disclosure Affidavit.docx NCHS Non-Disclosure Affidavit	IC Document
Attachment 9-Data Retention Policy.docx Data Retention Policy	IC Document
Attachment 9-Data Retention Policy.docx Data Retention Policy	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[NCHS] Evaluation of Revised Questions on Cannabis Use and Experiences

Agency IC Tracking Number:

0920-0222-24CS

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 and Instruction	n/a	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Yes	No	Fillable Fileable
Form and Instruction	n/a	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: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	58	58
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA		02/05/2024
Question Provenance		02/05/2024
Cannabis Advertisment		02/05/2024
Informed Consent		02/05/2024
Thank You Letter		02/05/2024
NCHS Non-Disclosure Affidavit		02/05/2024
Data Retention Policy		02/05/2024

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

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