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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
NHIS 2023 Indicators Cognitive Interview Evaluation Study
Agency IC Tracking Number:
0920-0222-22FX
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
Cognitive Testing Questions
Attachment 1 - CognitiveTesting Questions NHIS 2023 Indicators_final.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0222
Screening Form
Attachment 4- Screening script-NHIS 2023 Indicators V3.docx
Yes
No
Fillable Fileable
Form and Instruction
0920-0222
Respondent Data Collection Sheet
Attachment 6a&b- Respondent Data Collection Sheet-NHIS 2023 Indicators.docx
Yes
No
Fillable Fileable
Other-Header and Burden Statement
Virtual Interview Zoom Skype Support.docx
No
Fillable Fileable
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 09-20-0164
FR Citation:
49 FR 37693
Number of Respondents:
192
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
50 %
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
192
0
192
0
0
0
Annual IC Time Burden (Hours)
50
0
50
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
10 Day Letter
10-day letter NHIS 2023 Indicators V4 5.24.22_CLEAN_final.docx
06/02/2022
Invitation Letter
Attachment 2ab- Invitation Letter- NHIS 2023 indicators 5.20.22.docx
06/02/2022
Advertisement
Attachment 3a&b- Advertisement-NHIS 2023 Indicators.docx
06/02/2022
Informed Consent
Attachment 5a&b - Informed Consent-NHIS 2023 Indicators.docx
06/02/2022
Data Retention Policy
Attachment 7-Data Retention Policy-NHIS 2023 Indicators.docx
06/02/2022
Thank You Letter
Attachment 8- Thank you letter-NHIS 2023 Indicators.docx
06/02/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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The .gov means it's official.
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