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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Center for Questionnaire Design and Evaluation Research (CQDER) CMS 10-day Letter
Agency IC Tracking Number:
16AEE
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
Instruction
CQDER CMS Att 2ab Recruit Msg.docx
Yes
Yes
Fillable Printable
Form and Instruction
0920-16AEE
CQDER CMS Att 3ab Telephone Screener
CQDER CMS Att 3ab Telephone Screener.docx
Yes
Yes
Fillable Printable
Form and Instruction
0920-16AEE
CQDER CMS Att 5ab Resp Data Collect
CQDER CMS Att 5ab Resp Data Collect.docx
Yes
Yes
Fillable Printable
Form and Instruction
0920-16AEE
CQDER CMS Att 1ab Qnne wshowcards
CQDER CMS Att 1ab Qnne wshowcards.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 Probability Samples of the U. S. Population 09-20-0164
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:
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
100
0
100
0
0
0
Annual IC Time Burden (Hours)
50
0
50
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
CQDER CMS 10-day Letter 042016
CQDER CMS 10-day Letter 042016.docx
04/26/2016
CQDER CMS Att 4ab Informed Consent
CQDER CMS Att 4ab Informed Consent 041916.docx
04/26/2016
CQDER CMS Att 6ab Thank You Letter
CQDER CMS Att 6ab Thank You Letter.docx
04/26/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.