Information Collection

[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research - RANDS 11

IC 272296 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⚠️ Notice: This information collection may be referencing outdated material.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:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research - RANDS 11	Form and Instruction
RANDS 11 Questionnaire-12.10.2024 [NCHS] Collaborating Center for Questionnaire Design and Evaluation Research - RANDS 11	Form and Instruction
RANDS 11 Questionnaire-12.10.2024 0920-0222 Attachment 1 - RANDS 11 Questionnaire.docx	Form and Instruction
RANDS 11 Questionnaire-12.10.2024 Attachment 1_RANDS 11 Questionnaire-10.15.24-JK_ZS_clean -jk.docx	Form and Instruction
Attachment 3 - NCHS Non-Disclosure Affidavit.docx NCHS Non-Disclosure Affidavit	IC Document
Attachment 3 - NCHS Non-Disclosure Affidavit.docx NCHS Non-Disclosure Affidavit	IC Document
Attachment 4-RANDS 11 IRB Approval.pdf Research Determination	IC Document
Attachment 4-RANDS 11 IRB Approval.pdf Research Determination	IC Document
RANDS 11_Supporting Statement A 11.5.24.docx SSA	IC Document
RANDS 11_Supporting Statement A 11.5.24.docx SSA	IC Document
Attachment 2_Previous Use and Development-jk2_zs_clean.docx Previous Use and Development	IC Document
Attachment 2_Previous Use and Development-jk2_zs_clean.docx Previous Use and Development	IC Document

IC Title:

[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research - RANDS 11

Agency IC Tracking Number:

0920-25-0099

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

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

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 18,600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	18,600	18,600
Annual IC Time Burden (Hours)	6,200	6,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NCHS Non-Disclosure Affidavit		11/12/2024
Research Determination		11/12/2024
SSA		11/12/2024
Previous Use and Development		12/10/2024

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

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