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Cognitive Test for NHIS Questions and Opiods 0920-0222-19AUJ
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0222 Questions to be Cognitively Tested GenIC 0920-0222 Cognitive Test NHIS & CCQDER Attach 1 Questions.docx No   Fillable Fileable
Form and Instruction 0920-0222 Screeners GenIC 0920-0222 Cognitive Test NHIS & CCQDER Attach 3ab Screeners.docx No   Fillable Fileable
Form and Instruction 0920-0222 Respondent Data Collection Sheet GenIC 0920-0222 Cognitive Test NHIS & CCQDER Attach 5 Resp Data.docx No   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

160 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 160 0 160 0 0 0
Annual IC Time Burden (Hours) 49 0 49 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
10 Day Letter (GenIC info) GenIC 0920-0222 NHIS and CCQDER 10-day letter 05 03 2019 ICRO.doc 05/20/2019
Ads GenIC 0920-0222 Cognitive Test NHIS & CCQDER Attach 2ab Ads.docx 05/20/2019
Consent GenIC 0920-0222 Cognitive Test NHIS & CCQDER Attach 4 Consent.docx 05/20/2019
Thank You Letter GenIC 0920-0222 Cognitive Test NHIS & CCQDER Attach 6 Letter.docx 05/20/2019
Special Consent GenIC 0920-0222 Cognitive Test NHSI & CCQDER Attach 7 Special Consent.docx 05/20/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.