View Information Collection (IC)

View Information Collection (IC)

Cognitive Testing of Middle Eastern North African (MENA) Questions
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form None Questions to be cognitively tested MENA Attach 1 - Qnne.docx Yes Yes Fillable Fileable
Form None Telephone screening script MENA Attach 3 -Screener.docx Yes Yes Fillable Fileable
Form None Respondent data collection sheet MENA Attach 5 - Resp Data Collection Sheet.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

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

316 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 316 0 316 0 0 0
Annual IC Time Burden (Hours) 118 0 118 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Advertisements and Flyers MENA Attach 2ab - adsflyers.docx 11/15/2016
Adult Informed Consent MENA Attach 4 - Consent.docx 11/15/2016
Adult Special Consent MENA Attach 7 - Adult Special Consent.docx 11/15/2016
Thank You Letter MENA Attach 6 - Thank You letter.docx 11/15/2016
Request for OMB Approval - Letter to Dr Schwab MENA 10-day letter rev.docx 11/15/2016
Additional Protocol Clarifications Additional_Clarification_20161213.docx 12/13/2016
Terms of Clearance Terms of Clearance.docx 12/13/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.