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

View Information Collection (IC)

Extended Puerto Rico Pilot
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction In-Person Screening Questions In-Person Screening Questions Attachment R_In-Person Screening Questions.docx Yes Yes Fillable Fileable
Form and Instruction Web-based CAI Questionnaire Web-based CAI Questionnaire Attachment U_In-Person CAI Questionnaire.docx Yes Yes Fillable Fileable
Form and Instruction Web-based CAI Questionnaire Web-based CAI Questionnaire Attachment WEB-4_Web-Based CAI Questionnaire.docx Yes Yes Fillable Fileable
Form and Instruction Web-based Screening Questions Web-based Screening Questions Attachment WEB-6_Web-Based Screening Questions.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

Privacy Act of 1974 (Title 5 United States Code [U.S.C.] 552a)  75 FR 28264

3,800 0
   
State, Local, and Tribal Governments
 
   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 3,800 0 3,800 0 0 0
Annual IC Time Burden (Hours) 1,304 0 1,304 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Extended PR Pilot SSB NSDUH Extended Puerto Rico Pilot_ SSB_6-26-24_Clean.docx 07/15/2024
Extended PR Pilot SSA NSDUH Extended Puerto Rico Pilot_SSA_7-11-24_Clean.docx 07/15/2024
Web Based Incentive Thank You Email Attachment WEB-7_Web-Based Incentive-Thank You Mailings.pdf 07/15/2024
PR Small Data Collection Effort Addendum 2023 PR Small Data Collection Effort Addendum.docx 07/15/2024
Lead Letter Attachment A_Lead Letter.docx 07/15/2024
In-Person Q&A Brochure Attachment B_In-Person Q&A Brochure.pdf 07/15/2024
Tablet Video Scripts Attachment C_Tablet Video Scripts.pdf 07/15/2024
Interview Appointment Card Attachment D_Interview Appointment Card.pdf 07/15/2024
In-Person Study Description Attachment E_In Person Study Description.pdf 07/15/2024
UTC and CA Letters Attachment F_UTC and CA Letters.pdf 07/15/2024
Refusal Letters Attachment G_Refusal Letters.pdf 07/15/2024
Interview Incentive Receipt Attachment H_Interview Incentive Receipt.pdf 07/15/2024
Federal wide Assurance Attachment I_Federalwide Assurance.pdf 07/15/2024
Intro and Informed Consent Script Attachment J_Intro and Informed Consent Script.pdf 07/15/2024
Showcard Booklet Attachment K_Showcard Booklet.pdf 07/15/2024
In-Person Parental Intro Script Attachment L_In Person Parental Intro Scripts.pdf 07/15/2024
Confidentiality and DC Agreement Attachment M_Confidentiality and DC Agreements.pdf 07/15/2024
Doorperson Card Attachment N_Doorperson Card.pdf 07/15/2024
NSDUH Highlights Attachment O_NSDUH Highlights.pdf 07/15/2024
Participant Code Card Attachment P_Participant Code Card.pdf 07/15/2024
Dara Security Handout Attachment Q_Data Security Handout.pdf 07/15/2024
Certificate of Participation Attachment S_Certificate of Participation.pdf 07/15/2024
Data Security Handout Attachment Q_Data Security Handout.pdf 07/15/2024
CATI Verification Scripts Attachment T_CATI Verification Scripts.pdf 07/15/2024
Web based Q&A Brochure Attachment WEB-1_Web-Based Q&A Brochure.pdf 07/15/2024
Web-based Study Description Attachment WEB-2_Web-Based Study Description.pdf 07/15/2024
Web Follow-up Letters Attachment WEB-3_Web Follow-up Letters.pdf 07/15/2024
Web Parent Permission Script Attachment WEB-5_Web Parent Permission Scripts.pdf 07/15/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.