View Information Collection (IC)

View Information Collection (IC)

Cognitive testing of Confidentiality Pledge, Round 2 16BFN
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Attach 3 Telehphone Screener.docx Yes Yes Fillable Printable
Other-WORD Attach 5 Resp Data Collect Sheet.docx Yes Yes Fillable Printable

Health Public Health Monitoring

09-06-0164 Health and Demographic Surveys Condcuted in Probability Samples of the U.S. Population   49 FR 37693

68 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 68 0 68 0 0 0
Annual IC Time Burden (Hours) 24 0 24 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att 1_ Confidentiality Pledge Attach 1 092616.docx 09/28/2016
Att 2_Ads & Flyers Attach 2 Advertisement&flyer.docx 09/28/2016
Att 4_Informed Consent Attach 4 Informed Consent.docx 09/28/2016
Att 6_Thank you Letter Attach 6 Thank You Letter.docx 09/28/2016
Att 7_Spec Consent Attach 7 Spec Consent.docx 09/28/2016
Request for Approval Confid Pledge 10-day letter 0928 2016.docx 09/28/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.