Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
2013 NHIS Health Insurance Web and Cognitive Interview Study New 1550 300 0 Form and Instruction none Screener
Instruction
Form and Instruction 4 Questionnaire
2015 NHIS Occupational Health Supplement and Cancer Control Supplement New 70 70 0 Other-WORD
Other-WORD
Form none Cancer Control - Questionniare
Form none Cancer Control - screener
2015 National Electronic Health Records Survey New 134 57 0 Form none National Electronic Health Records Survey 2015
Form and Instruction none Screener
Form none Respondent Data Sheet
4 Sets of Health Questions and Blood Donor History Questionnaire Evaluation New 125 125 0 Form and Instruction none Four Sets of Health Related Questions
Form and Instruction none Blood Donor History Questionnaire
Adult and Child Disability Questions New 100 100 0 Form and Instruction none Screening Script
Form none Adult Disability Questions
Form none Child Disability Questions
Cognitive Testing of Adults with Chronic Health Care Needs New 60 60 0 Form and Instruction none Adults with Chronic Health Care Needs
Cognitive testing of High-impact, Chronic Pain questions - NCHS Questionnaire Design Research Laboratory (QDRL) New 112 46 0 Form and Instruction None Telephone Screener
Form and Instruction None Pain Questionnaire to be evaluated
Diabetes Primary Prevention New 117 51 0 Form none Questionnaire
Form none Screener
Evaluate Cervical and Lung Cancer Screening Questions New 112 46 0 Form none Screener
Form none Questionnaire
Evaluation of Uniform Donor History Questionnaire and Evaluation of Violence Against Children Survey (VACS)- Malawi New 65 75 0 Form and Instruction None Attachment 1 Uniform Donor History Questionnaire
Form None What to do when a loved one dies-A survivor's checklist
Form None Attachment 1: Violence Against Children Survey - Malawi: Age 13-24 years
GENERIC IC Gen IC Questionnaire Design Research Lab - 2013 Comparative Disability Questions and Mode Effects Study New 120 180 0 Form None Attachment 1a: WHO Questionnaire
Form None Attachment 1b: Washington Group Questionnaire
Form and Instruction None Attachments 3a & 3b--Telephone Screeners
NAMCS Feasibility Study New 2268 779 0 Form and Instruction none Physician Survey
Form and Instruction none Medical Organization Survey
Form and Instruction none Phys and Organization Survey
NHIS College Housing Frame Questionnaire Study New 300 50 0 Other-WORD
Pregnancy Risk Assessment Monitoring System New 50 75 0 Form none PRAMS Phase 8
Form and Instruction none Screener
Form none Consent
Form none Respondent Data
Questionnaire Design Research Lab (2016 NAMCS Culturally and Linguistically Appropriate Services (CLAS) Supplement Evaluation) New 68 24 0 Form and Instruction 0920-0222 Attach 1 Q8 050615 (2)
Form and Instruction 0920-0222 Attach 3 - CLAS Phone screener
Questionnaire Design Research Lab: 5600 Case CAPI and ACASI NHIS Field Test New 5600 5600 0 Form and Instruction none Proposed ACASI Questions
Form and Instruction none HIS-100C, January 2011 Manual for NHIS Field Reps Explaning the Survey
Teen Disability and Demographic Questions Cognitive Interviewing Study New 200 100 0 Form and Instruction none Questionnaire
Form and Instruction none Screener
Testing Long-term Care Questions New 26 26 0 Form none NSLTP - Adult Day Services Center
Form none NSLTP - Residential Care Community
Form and Instruction none Screeners
UNICEF/Washington Group School Environment Study New 73 29 0 Form none Questionnaire
Form none Screener
Violence Against Children Survey Evaluation Study - Philippines New 40 80 0 Form none Violence Against Children Survey
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 11190 7873 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
To view an IC, click on IC Title