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 Yes Yes Fillable Fileable
Form and Instruction Web-based CAI Questionnaire Yes Yes Fillable Fileable
Form and Instruction Web-based CAI Questionnaire Yes Yes Fillable Fileable
Form and Instruction Web-based Screening Questions 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 07/15/2024
Extended PR Pilot SSA 07/15/2024
Web Based Incentive Thank You Email 07/15/2024
PR Small Data Collection Effort Addendum 07/15/2024
Lead Letter 07/15/2024
In-Person Q&A Brochure 07/15/2024
Tablet Video Scripts 07/15/2024
Interview Appointment Card 07/15/2024
In-Person Study Description 07/15/2024
UTC and CA Letters 07/15/2024
Refusal Letters 07/15/2024
Interview Incentive Receipt 07/15/2024
Federal wide Assurance 07/15/2024
Intro and Informed Consent Script 07/15/2024
Showcard Booklet 07/15/2024
In-Person Parental Intro Script 07/15/2024
Confidentiality and DC Agreement 07/15/2024
Doorperson Card 07/15/2024
NSDUH Highlights 07/15/2024
Participant Code Card 07/15/2024
Dara Security Handout 07/15/2024
Certificate of Participation 07/15/2024
Data Security Handout 07/15/2024
CATI Verification Scripts 07/15/2024
Web based Q&A Brochure 07/15/2024
Web-based Study Description 07/15/2024
Web Follow-up Letters 07/15/2024
Web Parent Permission Script 07/15/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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