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View Information Collection (IC)
View Information Collection (IC)
IC Title:
NSDUH SOGI Cognitive Interview Study
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
SOGI Cognitive Interview Protocol
SOGI Cognitive Interview Protocol
SOGI Cognitive Interview Protocol_Attachment G_04252022.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
SOGI Web Recruitment Screener
SOGI Web Recruitment Screener
Web Recruitment Screener_Attachment B_04272022.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
NSDUH SOGI Cognitive Interview Study
FR Citation:
75 FR 28264
Number of Respondents:
266
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
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
266
0
266
0
0
0
Annual IC Time Burden (Hours)
83
0
83
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
NSDUH SOGI Cognitive Interview Study Supporting Statement A
NSDUH SOGI Cognitive Interview Study Supporting Statement A_04252022.docx
05/05/2022
NSDUH SOGI Cognitive Interview Study Supporting Statement B
NSDUH SOGI Cognitive Interview Study Supporting Statement B_04252022.docx
05/05/2022
Parental Permission and Informed Consent Form_Attachment C
Parental Permission and Informed Consent Form_Attachment C_04252022.pdf
05/05/2022
Participant Informed Consent Assent Forms_Attachment D
Participant Informed Consent Assent Forms_Attachment D_04252022.pdf
05/05/2022
Receipt for Participation_Attachment E
Receipt for Participation_Attachment E_04252022.pdf
05/05/2022
Federalwide Assurance_Attachment F
Federalwide Assurance_Attachment F_04252022.pdf
05/05/2022
Recruitment Flyers_Attachment A
Recruitment Flyers_Attachment A_04282022.pdf
05/05/2022
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.
The site is secure.
