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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
2017 NHANES Health Behaviors Cognitive Interviewing Study
Agency IC Tracking Number:
16AG
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
0920-0222 (16AG)
Appendix 3 - NHANES Screener 090215
Appendix 3 - NHANES Screener 090215.docx
Yes
Yes
Fillable Printable
Form and Instruction
0920-0222 (16AG)
Appendix 1 - NHANES Questions for Cognitive Testing
Appendix 1 - NHANES Questions for Cognitive Testing 090215.docx
Yes
Yes
Fillable Printable
Form and Instruction
0920-0222 (16AG)
Appendix 2a&b - NHANES Adv Flyer
Appendix 2a&b - NHANES Adv Flyer.docx
Yes
Yes
Fillable Printable
Form and Instruction
0920-0222 (16AG)
Appendix 4 - NHANES Informed Consent
Appendix 4 - NHANES Informed Consent 090215.docx
Yes
Yes
Fillable Printable
Form and Instruction
0920-0222 (16AG)
Appendix 5 - Special Consent
Appendix 5 - Special Consent rev2.docx
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
Health and Demographic Surveys Conducted in Probablity Sampes of the U.S. Population 09-20-0164
FR Citation:
49 FR 37693
Number of Respondents:
156
Number of Respondents for Small Entity:
0
Affected Public:
Federal Government
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
156
0
156
0
0
0
Annual IC Time Burden (Hours)
68
0
68
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
10-day NHANES letter
10-day NHANES letter 100215.docx
10/07/2015
flashcard ALQ1
flashcard ALQ1.pdf
10/07/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.