OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

[NCHS] 2024 NHIS Diabetes

IC 272342 under ICR 202504-0920-019 · OMB 0920-0222.

Documents and Forms
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Form and Instruction
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Information Collection (IC) Details

View Information Collection (IC)

[NCHS] 2024 NHIS Diabetes 0920-0222-25BG
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0222 (25BG) Focus Grouip Protocol Attachment 1 - Focus Group Protocol-NHIS-diabetes.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0222 (25BG) Focus Group Telephone Screening Script Attachment 4 - Focus Group Screener.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0222 (25BG) Respondent Data Collection Sheet Attachment 6 - Data Collection Sheet.docx Yes No Fillable Fileable
Form and Instruction 0920-0222 (25BG) Cognitive Interviewing Telephone Screening Script Attachment 11 - Cognitive Interviewing Screening Script-CLEAN 10.28.24.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

108 0
   
Individuals or Households
 
   0 %

  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 108 0 0 0 0 108
Annual IC Time Burden (Hours) 144 0 0 0 0 144
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA Supporting Statement A -NHIS-Diabetes 11.1.24.docx 11/21/2024
IRB Approval Attachment 14- IRB Approval Letter.pdf 11/21/2024
NCHS Non Disclosure Attachment 9 - NCHS Non-Disclosure Affidavit.docx 11/21/2024
Previous use and Development Attachment 2- Previous Use and Development.docx 11/21/2024
Focus Group Advertisement/Flyer Attachment 3 - Focus Group Advertisement -.docx 11/21/2024
Adult Informed Consent Form for In-Person Attachment 5 - Focus Groups Informed Consent- CLEAN 10.28.24.docx 11/21/2024
Focus Group Thank you! Attachment 7 - Focus Group Thank You Letter.docx 11/21/2024
CCQDER Data Storage and Access Policy Attachment 8 - CCQDER Data Storage and Access Policy.docx 11/21/2024
Cognitive Interview Advertisement/flyer Attachment 10 - Cognitive Interviewing Advertisement.docx 11/21/2024
Adult informed consent for interviews conducted face-to-face Attachment 12 - Cognitive Interviewing Informed Consent.docx 11/21/2024
Cognitive Interviewing Thank You Letter Attachment 13 - Cognitive Interviewing Thank You Letter.docx 11/21/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.