Information Collection

[NCHS] 2024 NHIS Diabetes

IC 272342 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⚠️ Notice: This information collection may be referencing outdated material.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 (25BG) [NCHS] 2024 NHIS Diabetes	Form and Instruction
Form 0920-0222 (25BG) Focus Grouip Protocol [NCHS] 2024 NHIS Diabetes	Form and Instruction
Form 0920-0222 (25BG) Focus Group Telephone Screening Script [NCHS] 2024 NHIS Diabetes	Form and Instruction
Form 0920-0222 (25BG) Respondent Data Collection Sheet [NCHS] 2024 NHIS Diabetes	Form and Instruction
Form 0920-0222 (25BG) Cognitive Interviewing Telephone Screening Script [NCHS] 2024 NHIS Diabetes	Form and Instruction
0920-0222 (25BG) Focus Grouip Protocol Attachment 1 - Focus Group Protocol-NHIS-diabetes.docx	Form and Instruction
0920-0222 (25BG) Focus Grouip Protocol Attachment 1 - Focus Group Protocol-NHIS-diabetes.docx	Form and Instruction
0920-0222 (25BG) Focus Group Telephone Screening Script Attachment 4 - Focus Group Screener.docx	Form and Instruction
0920-0222 (25BG) Focus Group Telephone Screening Script Attachment 4 - Focus Group Screener.docx	Form and Instruction
0920-0222 (25BG) Respondent Data Collection Sheet Attachment 6 - Data Collection Sheet.docx	Form and Instruction
0920-0222 (25BG) Respondent Data Collection Sheet Attachment 6 - Data Collection Sheet.docx	Form and Instruction
0920-0222 (25BG) Cognitive Interviewing Telephone Screening Script Attachment 11 - Cognitive Interviewing Screening Script-CLEAN 10.28.24.docx	Form and Instruction
0920-0222 (25BG) Cognitive Interviewing Telephone Screening Script Attachment 11 - Cognitive Interviewing Screening Script-CLEAN 10.28.24.docx	Form and Instruction
Supporting Statement A -NHIS-Diabetes 11.1.24.docx SSA	IC Document
Supporting Statement A -NHIS-Diabetes 11.1.24.docx SSA	IC Document
Attachment 14- IRB Approval Letter.pdf IRB Approval	IC Document
Attachment 14- IRB Approval Letter.pdf IRB Approval	IC Document
Attachment 9 - NCHS Non-Disclosure Affidavit.docx NCHS Non Disclosure	IC Document
Attachment 9 - NCHS Non-Disclosure Affidavit.docx NCHS Non Disclosure	IC Document
Attachment 2- Previous Use and Development.docx Previous use and Development	IC Document
Attachment 2- Previous Use and Development.docx Previous use and Development	IC Document
Attachment 3 - Focus Group Advertisement -.docx Focus Group Advertisement/Flyer	IC Document
Attachment 3 - Focus Group Advertisement -.docx Focus Group Advertisement/Flyer	IC Document
Attachment 5 - Focus Groups Informed Consent- CLEAN 10.28.24.docx Adult Informed Consent Form for In-Person	IC Document
Attachment 5 - Focus Groups Informed Consent- CLEAN 10.28.24.docx Adult Informed Consent Form for In-Person	IC Document
Attachment 7 - Focus Group Thank You Letter.docx Focus Group Thank you!	IC Document
Attachment 7 - Focus Group Thank You Letter.docx Focus Group Thank you!	IC Document
Attachment 8 - CCQDER Data Storage and Access Policy.docx CCQDER Data Storage and Access Policy	IC Document
Attachment 8 - CCQDER Data Storage and Access Policy.docx CCQDER Data Storage and Access Policy	IC Document
Attachment 10 - Cognitive Interviewing Advertisement.docx Cognitive Interview Advertisement/flyer	IC Document
Attachment 10 - Cognitive Interviewing Advertisement.docx Cognitive Interview Advertisement/flyer	IC Document
Attachment 12 - Cognitive Interviewing Informed Consent.docx Adult informed consent for interviews conducted face-to-face	IC Document
Attachment 12 - Cognitive Interviewing Informed Consent.docx Adult informed consent for interviews conducted face-to-face	IC Document
Attachment 13 - Cognitive Interviewing Thank You Letter.docx Cognitive Interviewing Thank You Letter	IC Document
Attachment 13 - Cognitive Interviewing Thank You Letter.docx Cognitive Interviewing Thank You Letter	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[NCHS] 2024 NHIS Diabetes

Agency IC Tracking Number:

0920-0222-25BG

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0222 (25BG)	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0222 (25BG)	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0222 (25BG)	Yes	No	Fillable Fileable
Form and Instruction	0920-0222 (25BG)	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: 108

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

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA		11/21/2024
IRB Approval		11/21/2024
NCHS Non Disclosure		11/21/2024
Previous use and Development		11/21/2024
Focus Group Advertisement/Flyer		11/21/2024
Adult Informed Consent Form for In-Person		11/21/2024
Focus Group Thank you!		11/21/2024
CCQDER Data Storage and Access Policy		11/21/2024
Cognitive Interview Advertisement/flyer		11/21/2024
Adult informed consent for interviews conducted face-to-face		11/21/2024
Cognitive Interviewing Thank You Letter		11/21/2024

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

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