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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Cognitve Testing of Food for Babies and Mothers' Health Question on the NHANES B24 Month Questionnaire
Agency IC Tracking Number:
0920-0222 18GQ
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
Other-WORD
Attach 1a - Qnne (Eng) 112417.doc
No
Fillable Fileable
Other-WORD
Attach 1b - Qnne (Span) 112417.doc
No
Fillable Fileable
Other-WoRD
Attach 4a - Telephone Screener (Eng).docx
No
Fillable Fileable
Other-WORD
Attach 4b - Telephone Screener (Span) updated trans.docx
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the US Population
FR Citation:
49 FR 37693
Number of Respondents:
185
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
185
0
185
0
0
0
Annual IC Time Burden (Hours)
75
0
75
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Att 2a-d. English - Semi Targeted Advertisement
Attach 2a-d - Ads&Flyers (Eng & Span).docx
11/28/2017
Att 3. Sample Script of CCQDER Voice Mail
Attach 3 - Voice Mail Script (Eng only).docx
11/28/2017
Att 5a-b. Informed Consent (English/Spanish)
Attach 5ab - Informed Consent (Eng & Span).docx
11/28/2017
Att 6a-b. Resp Data Collect
Attach 6ab - Resp Data Collect (Eng & Span).docx
11/28/2017
Att 7a-b. Thank You Letter (English & Spanish)
Attach 7ab - Thank You Letter (Eng & Span).docx
11/28/2017
Att 8 a-b. Special Consent (English and Spanish)
Attach 8ab - Special Consent (Eng & Span).docx
11/28/2017
10 day Letter NHANES B24
10-day letter NHANES B24 112417.docx
11/28/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.