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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Yes	No	Fillable Fileable
Form and Instruction	n/a	Yes	Yes	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: 180

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
History and Development		03/05/2024
Advertisements		03/05/2024
Informed Consents		03/05/2024
SSA		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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