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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
RANDS - NISVS
Agency IC Tracking Number:
0920-0222-21GE
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
0920-0222
Questionnaire 55 minute
Att 2 - RANDS NSVIS Questionnaire and Intro Script-revised_55.docx
Yes
No
Fillable Fileable
Form and Instruction
0920-0222
Questionnaire 20 minute
Att 2 - RANDS NSVIS Questionnaire and Intro Script-revised_final.docx
Yes
No
Fillable Fileable
Form and Instruction
0920-0222
Telephone screener - flyer and database
Att 4ab - RANDS NISVS Telephone Screener CLEAN_final.docx
Yes
No
Fillable Fileable
Form and Instruction
0920-0222
Respondent Data Collection Sheet
Att 6- RANDS NISVS Resp Data Collect Sheet_final.docx
Yes
No
Fillable Fileable
Form and Instruction
0920-0222
Respondent Debriefing
Att 8 - RANDS NISVS Respondent Debriefing CLEAN.docx
Yes
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
6,780
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
90 %
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
6,780
0
6,780
0
0
0
Annual IC Time Burden (Hours)
2,242
0
2,242
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Overview of Procedures
Att 1 - RANDS NISVS Overview of Procedures CLEAN.docx
07/02/2021
RANDS NISVS Ads
Att 3ab - RANDS NISVS Ads CLEAN.docx
07/02/2021
Informed Consent
Att 5 - RANDS NISVS Informed Consent CLEAN.docx
07/02/2021
Thank You Letter
Att 7 - RANDS NISVS Thank You Letter.docx
07/02/2021
NORC Protection Plan
Att 9 - NORC CIPESA Protection Plan_vcb060421.docx
07/02/2021
Non-Disclosure Affidavit
Att 10 - NCHS Non-Disclosure Affidavit for NORC CLEAN.docx
07/02/2021
Distress Guide
Att 11 Distress guide.docx
07/02/2021
OMB 10-day Letter
OMB 10-day Letter_RANDS_NISVS 6 30 21.docx
07/02/2021
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.