View Information Collection (IC)

View Information Collection (IC)

IC Title:	QDRL - ACASI testing for sexual identity question on NHIS	Agency IC Tracking Number:

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	none	Att 2 - Cognitive testing interview guide	QDRL 10-day sex ID NHIS Attachment 2 ACASI instru-v2.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: Health and Demographic Surveys Conducted in Probablity Samples of the US Population	FR Citation: 49 FR 37693

Number of Respondents: 100	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	100	0	0	0	0	0
Annual IC Time Burden (Hours)	150	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
10 day letter to Dr. Schwab	QDRL OMB-10-day letter-A-CASI HR 041511.doc	04/25/2011
Att 3a - advertisement/flyer	QDRL 10-day sex ID NHIS Attachment 3 flyers.docx	04/25/2011
Att 1 - Instructions and introductory materials	OMB QDRL 10-day sex ID NHUIS Attachment 1 Intro materials-v2.docx	04/25/2011

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