Cognitive Testing of 2025 NSCH Questionnaire – EPA Items

Generic Clearance for Questionnaire Pretesting Research

Documents and Forms

Document Name Document Type
Form 1 Cognitive Testing of 2025 NSCH Questionnaire – EPA Items Form and Instruction
1 Protocol 2025 NSCH EPA Items Cognitive Interviewing Protocol_OMB.docx Form and Instruction
2025 NSCH EPA Items Cognitive Interviewing OMB Letter.docx OMB Memo IC Document
2025 NSCH EPA Items Cognitive Interviewing Participant Screener_OMB.docx Screener IC Document
2025 NSCH EPA Items Cognitive Interviewing Consent Form2_OMB.docx Consent Form IC Document

Information Collection (IC) Details

IC Title:	Cognitive Testing of 2025 NSCH Questionnaire – EPA Items	Agency IC Tracking Number:

IC Status: Unchanged

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	1	Protocol	2025 NSCH EPA Items Cognitive Interviewing Protocol_OMB.docx		No		Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	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	30	30
Annual IC Time Burden (Hours)	19	19
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo	2025 NSCH EPA Items Cognitive Interviewing OMB Letter.docx	10/10/2023
Screener	2025 NSCH EPA Items Cognitive Interviewing Participant Screener_OMB.docx	10/10/2023
Consent Form	2025 NSCH EPA Items Cognitive Interviewing Consent Form2_OMB.docx	10/10/2023

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