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[NCHS] Evaluation of Revised Questions on Cannabis Use and Experiences
[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research
OMB: 0920-0222
IC ID: 264921
OMB.report
HHS/CDC
OMB 0920-0222
ICR 202504-0920-019
IC 264921
( )
Documents and Forms
Document Name
Document Type
[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 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
SSA-Cannabis-2024-Streamline-1.30.24_final.docx
SSA
IC Document
Attachment 2 - Question Provenance.docx
Question Provenance
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 7- Thank You Letter.docx
Thank You Letter
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
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:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
n/a
Cannabis Questions to be Cognitively Tested
Attachment 1- Cannabis Questions.docx
Yes
Yes
Fillable Fileable
Form and Instruction
n/a
Cannabis Screening Script
Attachment 4 - Cannabis Screening Script- Clean 1.9.24.docx
Yes
No
Fillable Fileable
Form and Instruction
n/a
Cannabis Data Collection Sheet
Attachment 6- Cannabis Data Collection Sheet.docx
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 %
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
200
0
0
0
0
200
Annual IC Time Burden (Hours)
58
0
0
0
0
58
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SSA
SSA-Cannabis-2024-Streamline-1.30.24_final.docx
02/05/2024
Question Provenance
Attachment 2 - Question Provenance.docx
02/05/2024
Cannabis Advertisment
Attachment 3- Cannabis Advertisement.docx
02/05/2024
Informed Consent
Attachment 5 - Cannabis Informed Consent- CLEAN 1.5.24.docx
02/05/2024
Thank You Letter
Attachment 7- Thank You Letter.docx
02/05/2024
NCHS Non-Disclosure Affidavit
Attachment 8- NCHS Non-Disclosure Affidavit.docx
02/05/2024
Data Retention Policy
Attachment 9-Data Retention Policy.docx
02/05/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.