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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Cognitive Testing of Questions on Complementary Health Approaches and Well-being
Agency IC Tracking Number:
0920-20SN
IC Status:
New
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
n/a
Telephone Screener
Att3ab-CAM Telephone Screener.docx
No
Paper Only
Form and Instruction
n/a
NHIS Complementary Health Approaches and Well-being Questionnaire
Att1-CAM Questionnaire.docx
No
Paper Only
Form and Instruction
n/a
Respondent Data Collection Sheet [demographics]
Att5ab-CAM Resp Data Collect.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population
FR Citation:
49 FR 37693
Number of Respondents:
140
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
140
0
140
0
0
0
Annual IC Time Burden (Hours)
55
0
55
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Project Justification and Description
10-day letter CAM NHIS 9.29.2020v2.docx
10/05/2020
Recruitment Ads/Flyers
Att2ab-CAM Ad&flyer.docx
10/05/2020
Informed Consent
Att4ab-CAM Informed Consent.docx
10/05/2020
Thank You Letter to Participants
Att6-CAM Thank You Letter.docx
10/05/2020
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.