National Study of Health and Activity (NSHA)

ICR 200111-0960-002

OMB: 0960-0609

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
9603
Migrated
ICR Details
0960-0609 200111-0960-002
Historical Active 200109-0960-021
SSA
National Study of Health and Activity (NSHA)
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 01/02/2002
Retrieve Notice of Action (NOA) 11/28/2001
The pretest of the survey is approved consistent with the changes agreed to in the memo of 12/31/01, regarding the race/ethnicity questions on the screening and interview surveys. These will be changed to reflect the OMB standards. Approval of this pretest does not indicate approval of the methods or survey questions for the full-scale study. The study will have to be re-cleared through OMB after revisions are made based on pretest results. Because of this, approval is only granted for 1 year, with the option of extension based on demonstrated need for more time to complete pretest.
  Inventory as of this Action Requested Previously Approved
01/31/2003 01/31/2003
960 0 0
849 0 0
0 0 0

NSHA is a national disability study that consists of gathering information from interviews, medical examinations and medical records to be used to make simulated Disability Determination Service disability decisions. A pretest of the survey instruments and procedures is necessary prior to beginning the main study. Based on pretest results, the instruments and procedures will be further refined for the dress rehearsal and main study. The respondents are volunteers from SSA disability rolls and nondisabled individuals recruited from the community.

None
None


No

1
IC Title Form No. Form Name
National Study of Health and Activity (NSHA)

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 960 0 0 960 0 0
Annual Time Burden (Hours) 849 0 0 849 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
11/28/2001


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