View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

CCQDER's GEMS 0920-0222-22HA
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0222 Screener Script Attachment 3 - Screening script_7_6_2022.docx Yes No Fillable Fileable
Form and Instruction 0920-0222 Questions to be Tested Attachment 1- Questions to be cognitively tested_6_21_2022_ .docx Yes Yes Fillable Fileable
Form and Instruction 0920-0222 Respondent Data Collection Sheet Attachment 5 - Respondent Data Collection Sheet.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

Health and Demographic Surveys Conducted in Probability Samples of the U. S. Population 09-20-0164  49 FR 37693

400 0
   
Individuals or Households
 
   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 400 0 400 0 0 0
Annual IC Time Burden (Hours) 117 0 117 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
10 Day Letter GEMS 10 day letter-06_29_2022_final.docx 07/06/2022
Advertisements Attachment 2- Non-Specific Advertisement_6_17_2022.docx 07/06/2022
Informed Consent Attachment 4 - Informed Consent_6_17_2022.docx 07/06/2022
Data Retention Policy Attachment 6-Data Retention Policy.docx 07/06/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.