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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:
201506-0920-003
Status:
Historical Active
Previous ICR Reference No:
201205-0920-001
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:
07/21/2015
Retrieve Notice of Action (NOA)
Date Received in OIRA:
06/19/2015
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 cognitive 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
07/31/2018
36 Months From Approved
07/31/2015
Responses
24,000
0
9,300
Time Burden (Hours)
13,150
0
9,450
Cost Burden (Dollars)
0
0
0
Abstract:
The revision requested consists of an increase in burden hours for the next 3-year approval period. 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:
80 FR 13868
03/17/2015
30-day Notice:
Federal Register Citation:
Citation Date:
80 FR 34644
06/17/2015
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
31
IC Title
Form No.
Form Name
2016 CDC Healthcare Systems Scorecard (HSSC) Assessment Tool for Primary Care Practices
none, none, none
Screener
,
Interview Questionnaire
,
Demographic Sheet
2017 NHANES Health Behaviors Cognitive Interviewing Study
0920-0222 (16AG), 0920-0222 (16AG), 0920-0222 (16AG) , 0920-0222 (16AG), 0920-0222 (16AG)
Appendix 3 - NHANES Screener 090215
,
Appendix 1 - NHANES Questions for Cognitive Testing
,
Appendix 2a&b - NHANES Adv Flyer
,
Appendix 4 - NHANES Informed Consent
,
Appendix 5 - Special Consent
2017 NHANES Health Behaviors Cognitive Interviewing Study
2017 NHANES Health Behaviors Cognitive Interviewing Study/Spanish
0920-0222, 0920-0222, 0920-0222, 0920-0222
Appendix 1 Questionnaire Spanish NHANES 100215
,
Appendix 2a&b Ad&Flyer Spanish NHANES
,
Appendix 3 Telephone Screener Spanish NHANES 100215
,
Appendix 5 Resp Data Collection Sheet Spanish NHANES
CQDER - Opioid Plus Card Sort
0920-0222, 0920-0222
Opioid Questionnaire - Card Sort
,
Telephone Screener
Center for Questionnaire Design and Evaluation Research (CQDER) CMS 10-day Letter
0920-16AEE, 0920-16AEE, 0920-16AEE
CQDER CMS Att 3ab Telephone Screener
,
CQDER CMS Att 5ab Resp Data Collect
,
CQDER CMS Att 1ab Qnne wshowcards
Cognitive Interviewing Study of Opioid-Related Questions
n/a, n/a, n/a
Questionnaire for Cognitive Testing of Opioid Questions
,
Telephone Screener for Individuals Recruited through the Newspaper Ad
,
Respondent Data Collection Sheet (completed during the cognitive interview)
Cognitive Interviewing Study of Opioid-Related Questions (Spanish Version)
n/a, n/a, n/a
Sample screening script for respondent contact Cognitive interviewing study of opioid use and pain questions
,
Spanish Questions to be cognitively tested
,
Spanish Respondent Data Collection Sheet
Cognitive Testing of ASPE Criminal Justice System Questions
Cognitive Testing of Impaired Driving Questions for CDC National Center for Injury Prevention and Control (NPIPC)
0920-0222, 0920-0222
Imp Driving - Attach 3 Screener rev-kw
,
Imp Driving - Attach 5 Resp Data Collection Sheet
Cognitive Testing of Middle Eastern North African (MENA) Questions
None, None, None
Questions to be cognitively tested
,
Telephone screening script
,
Respondent data collection sheet
Cognitive Testing of NHIS health care utilization smoking, and selected child questions
092017AUC, 0920-17AUC
Attach 3 Telephone Screener vcb 051017kw no confid pld update
,
Attach 3 Telephone Screener vcb 051017kw no confid pld update
Cognitive Testing of National Survey of Hospital-Based Victim Services (NSHVS)
none, none
National Survey of Hospital-based Victim Services
,
Respondent Data Sheet
Cognitive Testing of Questions on Teen Alcohol and Marijuana Use
NA, NA
Telephone Screening Script- Cognitive Testing of Questions on Teen Alcohol and Marijuana Use
,
Teen Alcohol and Marijuana Use Questions to be Cognitively Tested
Cognitive testing of Confidentiality Pledge, Round 2
Cognitve Testing of Food for Babies and Mothers' Health Question on the NHANES B24 Month Questionnaire
Collaborating Center for Questionnaire Design and Evaluation Research (CCQDER)
0920-0222, 0920-0222, 0920-0222, 0920-0222
National Study of Long-Term Care Provider 2016 Adult Day Services Center Questionnaire
,
National Study of Long-Term Care Providers 2016 Residential Care Community Questionnaire
,
Adult Day Care Services Center (ADSC) Telephone Screening Script
,
Residential Care Community (RCC) Telephone Screening Script
Congitive Testing of Confidentiality Pledges
none
Respondent data collection sheet
Evaluation of Traumatic Brain Injury Questions for CDC's National Center for Injury Prevention and Control (NCIPC)
NA, NA
Telephone Screening Script for Adult/Self-Responder or Adult Proxy for Child 5-17
,
Questions to be Cognitively Tested
GenIC UNICEF/Washington Group School Environment Evaluation Study 2016
Labor Force Module of Persons with Disabilities
Labor Force Module of Persons with Disabilities Round 2
1
Questionnaire
NHANES Contact and Message Testing
PRAMS - English
none, none
PRAMS Phase 8 Supplemental Questions
,
PRAMS screener
PRAMS Phase 8 - Spanish
none, none, none
PRAMS Phase 8 - Spanish
,
Screener
,
Respondent Data Sheet
Questionnaire Design and Evaluation Research on Injury for the National Health Interview Survey (NHIS)
NA, NA
Telephone Screener
,
Questionnaire - Injury Questions to Evaluate
RANDS
none, none, none, none
Telephone Screener
,
Interview Questionnaire
,
Web Intro Screen
,
Respondent Demographic Data
Research and Development Survey (RANDS) Cognitive Interviewing Sub-Study
Spanish Cognitive Study to Examine Traumatic Brain Injury Questions
none, none, none
Spanish Questions - TBI
,
Spanish Telephone Screener
,
Spanish Data Collection Sheet
Testing of questions on cognitive functioning and other questions for the National Health Interview Survey (NHIS)
NA, NA
NHIS Cognitive Functioning and other questions to be cognitively tested
,
Telephone Screening Script
Trust, Acceptance and Confidence in Vaccines and Vaccination Schedules
NA, NA, NA, NA
Focus Group Screener
,
Cognitive Interview Screener
,
Focus Group Moderator Guide
,
Cognitive Interview Moderator Guide
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
24,000
9,300
0
14,700
0
0
Annual Time Burden (Hours)
13,150
9,450
0
3,700
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
CDC is requesting an increase in burden hours and respondents due to anticipated increase in the number and size of projects planned during the next 3 years.
Annual Cost to Federal Government:
$1,801,033
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:
Carol Marsh 404 639-4773 cww6@cdc.gov
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:
06/19/2015
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