View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research - RANDS 11	Agency IC Tracking Number:	0920-0222-25AY

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	n/a	RANDS 11 Questionnaire-12.10.2024	Attachment 1_RANDS 11 Questionnaire-10.15.24-JK_ZS_clean.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

	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	18,600	0	18,600	0	0	0
Annual IC Time Burden (Hours)	6,200	0	6,200	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
NCHS Non-Disclosure Affidavit	Attachment 3 - NCHS Non-Disclosure Affidavit.docx	11/12/2024
Research Determination	Attachment 4-RANDS 11 IRB Approval.pdf	11/12/2024
SSA	RANDS 11_Supporting Statement A 11.5.24.docx	11/12/2024
Previous Use and Development	Attachment 2_Previous Use and Development-jk2_zs_clean.docx	12/10/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.