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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Developmental Projects & Special Studies Testing
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
0920-0950
Introductory Letter for SP Questionnaire
Att_13a_Introductory Letter for SP Questionnaire 2022OCT13.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0950
NHANES Follow-Up Questionnaire
Att_3f2_NHANES_Follow_up_Questionnaire_v9_2022OCT13.pdf
NA
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0950
NHANES Refuser No Show Questionnaire
Att_3f4_NHANES_Refuser_No_Show_v8_02022OCT13.pdf
NA
Yes
Yes
Fillable Fileable
Other-Examples of Potential Special Studies
Att_16_Spec_Studies 2022OCT13.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:
09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population
FR Citation:
49 FR 37693
Number of Respondents:
3,500
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
3,500
0
0
0
0
3,500
Annual IC Time Burden (Hours)
10,500
0
0
0
0
10,500
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
MEC Follow-Up Letter
Att_3f1_MEC FollowUp_Letter_2022OCT13.docx
03/06/2023
MEC Refuser Letter
Att_3f3_MEC Refusers_Letter_2022OCT13.docx
03/06/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.