View Information Collection (IC)

View Information Collection (IC)

Cognitive testing of High-impact, Chronic Pain questions - NCHS Questionnaire Design Research Laboratory (QDRL) 0920-0222-15YY
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None Telephone Screener Attach 3 - Phone Screener - Pain.docx None Yes Yes Fillable Fileable
Form and Instruction None Pain Questionnaire to be evaluated Attach 1 - Qnne - Pain changes2 032615.docx None Yes Yes Fillable Fileable

Health Public Health Monitoring

09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U. S. Population  49 FR 37693

112 0
   
Individuals or Households
 
   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 112 0 112 0 0 0
Annual IC Time Burden (Hours) 46 0 46 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
NCHS QDRL Request (Letter to M. Schwab) 0920-0222 QDRL Pain ltr 033015.docx 04/03/2015
Advertisement - Participants Wanted for Research Study Attach 2 - Adflyer - Pain.docx 04/03/2015
Informed Consent Form 1 on 1 Interviews Attach 4 - Informed Consent - Pain 032615.docx 04/03/2015
Special Consent - Use of Video/Audio Recordings Attach 5 - Special Consent -Pain.docx 04/03/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.