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Federal forms, ICRs, and supporting documents

Information Collection

[NCHS] Point of Care Checklist Subproject 1: Conducting In-depth Interviews Among Those with Intellectual and Developmental Disabilities

IC 265792 under ICR 202504-0920-019 · OMB 0920-0222.

Documents and Forms
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Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

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[NCHS] Point of Care Checklist Subproject 1: Conducting In-depth Interviews Among Those with Intellectual and Developmental Disabilities 0920-0222-24DL
 
Unchanged
 
Voluntary
 

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

Health Public Health Monitoring

 

180 0
   
Individuals or Households
 
   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

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.