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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Cognitive Testing of NHIS health care utilization smoking, and selected child questions
Agency IC Tracking Number:
0920-17AUC
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
092017AUC
Attach 3 Telephone Screener vcb 051017kw no confid pld update
Attach 3 Telephone Screener vcb 051017kw no confid pld update.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-17AUC
Attach 3 Telephone Screener vcb 051017kw no confid pld update
Attach 5 Resp Data Collect Sheet.docx
Yes
Yes
Fillable Fileable
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:
112
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
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
Documents for IC
Title
Document
Date Uploaded
10-day letter HIS Redesign 0626 2017
10-day letter HIS Redesign 0626 2017.docx
06/27/2017
Attach 1 HIS Redesign Qnne vcb 051017kw no confid pledge change
Attach 1 HIS Redesign Qnne vcb 051017kw no confid pledge change.docx
06/27/2017
Attach 2a&b Adv&Flyer
Attach 2a&b Adv&Flyer.docx
06/27/2017
Attach 4 Informed Consent vcb 051017kw no confid pled update
Attach 4 Informed Consent vcb 051017kw no confid pled update.docx
06/27/2017
C
C.docx
06/27/2017
Attach 6 Thank You Letter
Attach 6 Thank You Letter.docx
06/27/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.