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.

⚠️ Notice: This information collection may be referencing outdated material.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

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 [NCHS] Point of Care Checklist Subproject 1: Conducting In-depth Interviews Among Those with Intellectual and Developmental Disabilities Form and Instruction
Interviewer's Guide [NCHS] Point of Care Checklist Subproject 1: Conducting In-depth Interviews Among Those with Intellectual and Developmental Disabilities Form and Instruction
Data Collection Sheets [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
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
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
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 2 - history and development_FV.docx History and Development IC Document
Attachment 3- Advertisements V2 CLEAN 2.27.24.docx Advertisements 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
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
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	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	Previously Approved
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	61	61
Annual IC Cost Burden (Dollars)	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.

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