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View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View Generic ICR - OIRA Conclusion
OMB Control No:
0920-0222
ICR Reference No:
201205-0920-001
Status:
Historical Active
Previous ICR Reference No:
201002-0920-006
Agency/Subagency:
HHS/CDC
Agency Tracking No:
Title:
NCHS Questionnaire Design Research Laboratory
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
06/13/2012
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/10/2012
Terms of Clearance:
CDC will continue to submit individual collections under this generic clearance to OMB. OMB will strive to provide feedback on the individual collections within ten working days, whenever possible, as is currently the case. Standard remuneration of respondents for congantive testing is $40.00. Higher remunerations may be requested with justification for difficult recruitments, focus groups, etc.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2015
36 Months From Approved
03/31/2013
Responses
9,300
0
850
Time Burden (Hours)
9,450
0
1,800
Cost Burden (Dollars)
0
0
0
Abstract:
This submission describes proposed research activities of the National Center for Health Statistics (NCHS) Questionnaire Design Research Laboratory. Survey specific research activities include questionnaire development, pre-testing, and evaluation activities for NCHS, CDC, other federal agencies, or other academic or professional institutions. The purpose and use of collecting this information fall into five categories: 1) Development and testing of specific survey questionnaires; 2) Research on the cognitive and interpretive aspects of survey methodology; 3) Research on human-computer interfaces/usability; 4) Field tests/Pilot interviewing; and 5) Studies of the optimal design and presentation of statistical graphical and textual material. Methods for data collection include interviewer administered, self-administered, telephone, Computer Assisted Personal Interviewing (CAPI) and Computer Assisted Self-Interviewing (CASI), Audio Computer-Assisted Self-Interviewing (ACASI), and web-based questionnaires including: cognitive interviewing, focus groups, usability testing, and field tests/pilot household interviews.
Authorizing Statute(s):
US Code:
42 USC 242k
Name of Law: Public Health Service Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
77 FR 11124
02/24/2012
30-day Notice:
Federal Register Citation:
Citation Date:
77 FR 27064
05/08/2012
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
20
IC Title
Form No.
Form Name
2013 NHIS Health Insurance Web and Cognitive Interview Study
none, 4
Screener
,
Questionnaire
2015 NHIS Occupational Health Supplement and Cancer Control Supplement
none, none
Cancer Control - Questionniare
,
Cancer Control - screener
2015 National Electronic Health Records Survey
none, none, none
National Electronic Health Records Survey 2015
,
Screener
,
Respondent Data Sheet
4 Sets of Health Questions and Blood Donor History Questionnaire Evaluation
none, none
Four Sets of Health Related Questions
,
Blood Donor History Questionnaire
Adult and Child Disability Questions
none, none, none
Screening Script
,
Adult Disability Questions
,
Child Disability Questions
Cognitive Testing of Adults with Chronic Health Care Needs
none
Adults with Chronic Health Care Needs
Cognitive testing of High-impact, Chronic Pain questions - NCHS Questionnaire Design Research Laboratory (QDRL)
None, None
Telephone Screener
,
Pain Questionnaire to be evaluated
Diabetes Primary Prevention
none, none
Questionnaire
,
Screener
Evaluate Cervical and Lung Cancer Screening Questions
none, none
Screener
,
Questionnaire
Evaluation of Uniform Donor History Questionnaire and Evaluation of Violence Against Children Survey (VACS)- Malawi
None, None, None
Attachment 1 Uniform Donor History Questionnaire
,
What to do when a loved one dies-A survivor's checklist
,
Attachment 1: Violence Against Children Survey - Malawi: Age 13-24 years
GENERIC IC Gen IC Questionnaire Design Research Lab - 2013 Comparative Disability Questions and Mode Effects Study
None, None, None
Attachment 1a: WHO Questionnaire
,
Attachment 1b: Washington Group Questionnaire
,
Attachments 3a & 3b--Telephone Screeners
NAMCS Feasibility Study
none, none, none
Physician Survey
,
Medical Organization Survey
,
Phys and Organization Survey
NHIS College Housing Frame Questionnaire Study
Pregnancy Risk Assessment Monitoring System
none, none, none, none
PRAMS Phase 8
,
Screener
,
Consent
,
Respondent Data
Questionnaire Design Research Lab (2016 NAMCS Culturally and Linguistically Appropriate Services (CLAS) Supplement Evaluation)
0920-0222, 0920-0222
Attach 1 Q8 050615 (2)
,
Attach 3 - CLAS Phone screener
Questionnaire Design Research Lab: 5600 Case CAPI and ACASI NHIS Field Test
none, none
Proposed ACASI Questions
,
HIS-100C, January 2011 Manual for NHIS Field Reps Explaning the Survey
Teen Disability and Demographic Questions Cognitive Interviewing Study
none, none
Questionnaire
,
Screener
Testing Long-term Care Questions
none, none, none
NSLTP - Adult Day Services Center
,
NSLTP - Residential Care Community
,
Screeners
UNICEF/Washington Group School Environment Study
none, none
Questionnaire
,
Screener
Violence Against Children Survey Evaluation Study - Philippines
none
Violence Against Children Survey
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
9,300
850
0
0
8,450
0
Annual Time Burden (Hours)
9,450
1,800
0
0
7,650
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$1,571,700
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Petunia Gissendaner 4046390164
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
05/10/2012
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