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CCQDER - Questions on Subjective Cognitive Decline 0920-0222-24HK
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0222 Cognitive Decline - Screening Script Attachment 4 - Screening Script CD- Clean 7.12.24.docx N/A No   Fillable Fileable
Form and Instruction 0920-0222 Questions to be Cognitively Tested Attachment 1 Questions CD.docx N/A Yes Yes Fillable Fileable
Form and Instruction 0920-0222 Respondent Data Collection Sheet Attachment 6ab - (In Person & Virtual) Respondent Data Collection Sheet- CLEAN 7.12.24.docx N/A 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

120 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 120 0 120 0 0 0
Annual IC Time Burden (Hours) 35 0 35 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Purpose and Development of Cognitive Decline Questions Attachment 2- Purpose and Development of Questions CD- Clean 6.12.24.docx 07/11/2024
Suspected and Diagnosed Cognitive Decline Advertisements Attachment 3ab- Suspected and Diagnosed Cog Decline Advertisements CD 6.5.24.docx 07/11/2024
Informed Consent Forms Attachment 5ab - (In Person & Virutal) - Informed Consent Forms CD 6.5.24.docx 07/11/2024
Thank You Letter Attachment 7 Thank You Letter.docx 07/11/2024
Data Retention Policy Attachment 8 Data Retention Policy.docx 07/11/2024
Non-Disclosure Affidavit Attachment 9 NCHS Non-Disclosure Affidavit- Clean 6.12.24.docx 07/11/2024
Distress Guide Attachment 10- Distress Guide.docx 07/11/2024
Exempt Research Determination Attachment 11- 7500 Exempt Research Approval Letter.pdf 07/11/2024
Supporting Statement A / GenIC Template Supporting Statement A CD 7.8.24 FINAL.docx 07/11/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.