View Information Collection (IC)

View Information Collection (IC)

IC Title:	Cognitive Testing of 2025 NSCH Questionnaire – EPA Items	Agency IC Tracking Number:

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	1	Protocol	2025 NSCH EPA Items Cognitive Interviewing Protocol_OMB.docx		No		Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	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	30	0	30	0	0	0
Annual IC Time Burden (Hours)	19	0	19	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo	2025 NSCH EPA Items Cognitive Interviewing OMB Letter.docx	10/10/2023
Screener	2025 NSCH EPA Items Cognitive Interviewing Participant Screener_OMB.docx	10/10/2023
Consent Form	2025 NSCH EPA Items Cognitive Interviewing Consent Form2_OMB.docx	10/10/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.