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[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research - RANDS 11
[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research
OMB: 0920-0222
IC ID: 272296
OMB.report
HHS/CDC
OMB 0920-0222
ICR 202504-0920-019
IC 272296
( )
Documents and Forms
Document Name
Document Type
[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
Attachment 3 - NCHS Non-Disclosure Affidavit.docx
NCHS Non-Disclosure Affidavit
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
Attachment 2_Previous Use and Development-jk2_zs_clean.docx
Previous Use and Development
IC Document
Information Collection (IC) Details
View Information Collection (IC)
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:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
n/a
RANDS 11 Questionnaire-12.10.2024
0920-0222 Attachment 1 - RANDS 11 Questionnaire.docx
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:
18,600
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
90 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
18,600
0
0
0
0
18,600
Annual IC Time Burden (Hours)
6,200
0
0
0
0
6,200
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
NCHS Non-Disclosure Affidavit
Attachment 3 - NCHS Non-Disclosure Affidavit.docx
11/12/2024
Research Determination
Attachment 4-RANDS 11 IRB Approval.pdf
11/12/2024
SSA
RANDS 11_Supporting Statement A 11.5.24.docx
11/12/2024
Previous Use and Development
Attachment 2_Previous Use and Development-jk2_zs_clean.docx
12/10/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.