[NCHS] genIC Attention Deficient Hyperactivity Disorder Questions

[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research

Documents and Forms

Document Name Document Type
Form 0920-0222 [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 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
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 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 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 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

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	0920-0222	Attachment 6 Respondent Data Collection Sheet	Attachment 6 Respondent Data Collection Sheet_ CLEAN 4.29.24.docx	No	Printable Only
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	No	Printable Only
Form and Instruction	0920-0222	Attachment 5 Informed Consent ADHD	Attachment 5 Informed Consent_ADHD.docx	No	Printable Only

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 %

	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

Title	Document	Date Uploaded
Previous use and development (24DR)	Attachment 2 Previous use and development of Questions_ ADHD_3.11.24.docx	03/14/2024
Participants Wanted for Research Study_Advertisement/Flyer (24DR)	Attachment 3 Advertisement_ ADHD.docx	03/14/2024
Attachment 5a – Adult informed consent for interviews (24DR)	Attachment 5 Informed Consent_ADHD.docx	03/20/2024
Attachment 7 Thank You Letter (24DR)	Attachment 7 Thank You Letter.docx	03/20/2024
CCQDER Data Storage and Access Policy (24DR)	Attachment 8 Data Retention Policy.docx	03/20/2024
NCHS Non-Disclosure Affidavit (24DR)	Attachment 9 NCHS Non-Disclosure Affidavit.docx	03/20/2024
Approval of Exempt Research Protocol 7488, “ADHD Questions” (24DR)	Attachment 10 Exempt Research Approval_01222024.pdf	03/20/2024
SSA (24DR)	Supporting Statement A_ ADHD Questions 3.19.24_Clean.docx	03/20/2024

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