View Information Collection (IC)

View Information Collection (IC)

Questionnaire Design and Evaluation Research on Injury for the National Health Interview Survey (NHIS) 0920-0222-18DO
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA Telephone Screener Attach 3 - Telephone Screener.docx NA No   Paper Only
Form and Instruction NA Questionnaire - Injury Questions to Evaluate Attach 1 - Questionnaire.docx NA No   Paper Only

Health Public Health Monitoring

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

68 0
   
Individuals or Households
 
   0 %

  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
Study Participation Ad/Flyer Attach 2a&b Ads&Flyers.docx 10/27/2017
Informed Consent - Interview Attach 4 - Informed Consent.docx 10/27/2017
Special Consent for Expanded Use of Video and Audio Recordings Attach 7 - Spec Consent.docx 10/27/2017
Respondent Data Collection Sheet Attach 5 - Resp Data Collect Sheet.docx 10/27/2017
Thank You Letter Attach 6 - Thank You Ltr.docx 10/27/2017
10-Day Letter 10-day letter NHIS Injury 102617.docx 10/27/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.