View Information Collection (IC)

View Information Collection (IC)

Questionnaire Design Research Lab (2016 NAMCS Culturally and Linguistically Appropriate Services (CLAS) Supplement Evaluation) 15AEM
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0222 Attach 1 Q8 050615 (2) Attach 1 Q8 050615 (2).docx Yes Yes Fillable Fileable
Form and Instruction 0920-0222 Attach 3 - CLAS Phone screener Attach 3 - CLAS Phone screener.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

68 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved 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 68 0 68 0 0 0
Annual IC Time Burden (Hours) 24 0 24 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CLAS 10day letter 041015 CLAS 10day letter 041015.docx 05/07/2015
Attach 5 - CLAS Resp data sheet Attach 5 - CLAS Resp data sheet.docx 05/07/2015
Attach 2 - CLAS Advance letter Attach 2 - CLAS Advance letter.doc 05/07/2015
Attach 4 - CLAS Informed consent Attach 4 - CLAS Informed consent.docx 05/07/2015
Attach 6 - CLAS Special consent Attach 6 - CLAS Special consent.docx 05/07/2015
Attach 7 - CLAS Thank you letter Attach 7 - CLAS Thank you letter.docx 05/07/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.