View Information Collection (IC)

View Information Collection (IC)

IC Title:	Cognitive Testing of Adults with Chronic Health Care Needs	Agency IC Tracking Number:	14ARU

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	none	Adults with Chronic Health Care Needs	0920-0222 QDRL ACHCN Attach 1 Resp Screener Instrument 072414.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

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

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 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	60	0	60	0	0	0
Annual IC Time Burden (Hours)	60	0	60	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Letter to Dr. Schwab	0920-0222 QDRL ACHCN letter072914.docx	08/06/2014
Advertisements	0920-0222 QDRL ACHCN Attach2abc Adv.docx	08/06/2014

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