[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

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

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

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.