Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Cognitive Test for ACS Disability Questions and NHIS Child Behavior Questions
Agency IC Tracking Number:
0920-19AYX
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
n/a
Telephone Screener
0920-0222 Attach 3ab Telephone Screeners ACS & NHIS.doc
No
Paper Only
Form and Instruction
n/a
ACS Booklet and Selected NHIS Questions Discussed During the Cognitive Interview
0920-0222 Attach 1 ACS Disability & NHIS Child Behavavior.pdf
No
Paper Only
Form and Instruction
n/a
Respondent Data Collection Sheet (Demographics)
0920-0222 Attach 5 Resp Data ACS & NHIS.doc
No
Paper Only
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, SORN 09-20-0164
FR Citation:
49 FR 37693
Number of Respondents:
80
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
80
0
80
0
0
0
Annual IC Time Burden (Hours)
47
0
47
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Project Description and Justification
0920-0222 Justification Cognitive Testing ACS and NHIS Questions.doc
05/16/2019
Recruitment Materials
0920-0222 Attach 2ab Adsflyers ACS & NHIS.doc
05/16/2019
Informed Consent
0920-0222 Attach 4 Informed Consent ACS & NHIS Questions.doc
05/16/2019
Thank-you Letter
0920-0222 Attach 6 Thank You Letter ACS & NHIS.doc
05/16/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.