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[NCHS] Point of Care Checklist Subproject 1: Conducting In-depth Interviews Among Those with Intellectual and Developmental Disabilities
[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research
OMB: 0920-0222
IC ID: 265792
OMB.report
HHS/CDC
OMB 0920-0222
ICR 202504-0920-019
IC 265792
( )
Documents and Forms
Document Name
Document Type
[NCHS] Point of Care Checklist Subproject 1: Conducting In-depth Interviews Among Those with Intellectual and Developmental Disabilities
Form and Instruction
Telephone Screening Script
Attachment 4 -Screening Script 2.1.24.docx
Form and Instruction
Interviewer's Guide
Attachment 1 - Topic guide FV2 CLEAN 2.27.24.docx
Form and Instruction
Data Collection Sheets
Sample Resp Data Collect Sheet.docx
Form and Instruction
Attachment 2 - history and development_FV.docx
History and Development
IC Document
Attachment 3- Advertisements V2 CLEAN 2.27.24.docx
Advertisements
IC Document
Attachment 5 -Informed Consents 2.1.24.docx
Informed Consents
IC Document
SSA-IDD Point of Care Checklist Development_FV2 CLEAN 3.1.24_final.docx
SSA
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
[NCHS] Point of Care Checklist Subproject 1: Conducting In-depth Interviews Among Those with Intellectual and Developmental Disabilities
Agency IC Tracking Number:
0920-0222-24DL
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
Telephone Screening Script
Attachment 4 -Screening Script 2.1.24.docx
Yes
No
Fillable Fileable
Form and Instruction
n/a
Interviewer's Guide
Attachment 1 - Topic guide FV2 CLEAN 2.27.24.docx
Yes
Yes
Fillable Fileable
Form and Instruction
n/a
Data Collection Sheets
Sample Resp Data Collect 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:
180
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
180
0
0
0
0
180
Annual IC Time Burden (Hours)
61
0
0
0
0
61
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
History and Development
Attachment 2 - history and development_FV.docx
03/05/2024
Advertisements
Attachment 3- Advertisements V2 CLEAN 2.27.24.docx
03/05/2024
Informed Consents
Attachment 5 -Informed Consents 2.1.24.docx
03/05/2024
SSA
SSA-IDD Point of Care Checklist Development_FV2 CLEAN 3.1.24_final.docx
03/05/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.