Information Collection

[NCHS] genIC Attention Deficient Hyperactivity Disorder Questions

IC 266008 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-0222 [NCHS] genIC Attention Deficient Hyperactivity Disorder Questions	Form and Instruction
Form 0920-0222 Attachment 6 Respondent Data Collection Sheet [NCHS] genIC Attention Deficient Hyperactivity Disorder Questions	Form and Instruction
Form 0920-0222 ADHD Attachment 1 Questions to be tested [NCHS] genIC Attention Deficient Hyperactivity Disorder Questions	Form and Instruction
Form 0920-0222 Attachment 5 Informed Consent ADHD [NCHS] genIC Attention Deficient Hyperactivity Disorder Questions	Form and Instruction
0920-0222 Attachment 6 Respondent Data Collection Sheet Attachment 6 Respondent Data Collection Sheet_ CLEAN 4.29.24.docx	Form and Instruction
0920-0222 Attachment 6 Respondent Data Collection Sheet Attachment 6 Respondent Data Collection Sheet_ CLEAN 4.29.24.docx	Form and Instruction
0920-0222 ADHD Attachment 1 Questions to be tested 0920-0222-ADHD-Attachment 1 Questions to be tested_ ADHD_V2 4.25.24.docx	Form and Instruction
0920-0222 ADHD Attachment 1 Questions to be tested 0920-0222-ADHD-Attachment 1 Questions to be tested_ ADHD_V2 4.25.24.docx	Form and Instruction
0920-0222 Attachment 5 Informed Consent ADHD Attachment 5 Informed Consent_ADHD.docx	Form and Instruction
0920-0222 Attachment 5 Informed Consent ADHD Attachment 5 Informed Consent_ADHD.docx	Form and Instruction
Attachment 2 Previous use and development of Questions_ ADHD_3.11.24.docx Previous use and development (24DR)	IC Document
Attachment 2 Previous use and development of Questions_ ADHD_3.11.24.docx Previous use and development (24DR)	IC Document
Attachment 3 Advertisement_ ADHD.docx Participants Wanted for Research Study_Advertisement/Flyer (24DR)	IC Document
Attachment 3 Advertisement_ ADHD.docx Participants Wanted for Research Study_Advertisement/Flyer (24DR)	IC Document
Attachment 5 Informed Consent_ADHD.docx Attachment 5a – Adult informed consent for interviews (24DR)	IC Document
Attachment 5 Informed Consent_ADHD.docx Attachment 5a – Adult informed consent for interviews (24DR)	IC Document
Attachment 7 Thank You Letter.docx Attachment 7 Thank You Letter (24DR)	IC Document
Attachment 7 Thank You Letter.docx Attachment 7 Thank You Letter (24DR)	IC Document
Attachment 8 Data Retention Policy.docx CCQDER Data Storage and Access Policy (24DR)	IC Document
Attachment 8 Data Retention Policy.docx CCQDER Data Storage and Access Policy (24DR)	IC Document
Attachment 9 NCHS Non-Disclosure Affidavit.docx NCHS Non-Disclosure Affidavit (24DR)	IC Document
Attachment 9 NCHS Non-Disclosure Affidavit.docx NCHS Non-Disclosure Affidavit (24DR)	IC Document
Attachment 10 Exempt Research Approval_01222024.pdf Approval of Exempt Research Protocol 7488, “ADHD Questions” (24DR)	IC Document
Attachment 10 Exempt Research Approval_01222024.pdf Approval of Exempt Research Protocol 7488, “ADHD Questions” (24DR)	IC Document
Supporting Statement A_ ADHD Questions 3.19.24_Clean.docx SSA (24DR)	IC Document
Supporting Statement A_ ADHD Questions 3.19.24_Clean.docx SSA (24DR)	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[NCHS] genIC Attention Deficient Hyperactivity Disorder Questions

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Electronic Capability
Form and Instruction	0920-0222	No	Printable Only
Form and Instruction	0920-0222	No	Printable Only
Form and Instruction	0920-0222	No	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population.

FR Citation: 83 FR 6591

Number of Respondents: 70

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	70	70
Annual IC Time Burden (Hours)	56	56
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Previous use and development (24DR)		03/14/2024
Participants Wanted for Research Study_Advertisement/Flyer (24DR)		03/14/2024
Attachment 5a â Adult informed consent for interviews (24DR)		03/20/2024
Attachment 7 Thank You Letter (24DR)		03/20/2024
CCQDER Data Storage and Access Policy (24DR)		03/20/2024
NCHS Non-Disclosure Affidavit (24DR)		03/20/2024
Approval of Exempt Research Protocol 7488, âADHD Questionsâ (24DR)		03/20/2024
SSA (24DR)		03/20/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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