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[NCHS] Collaborating Center For Questionnaire Design and Evaluation Research
[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research
OMB: 0920-0222
IC ID: 259654
OMB.report
HHS/CDC
OMB 0920-0222
ICR 202212-0920-003
IC 259654
( )
Documents and Forms
Document Name
Document Type
Form 0920-0222-23EC
[NCHS] Collaborating Center For Questionnaire Design and Evaluation Research
Form and Instruction
0920-0222-23EC RANDS 8 Questionnaire
Attachment 1 -RANDS 8 Questionnaire.docx
Form and Instruction
Attachment 2- Advertisement.docx
Attachment 2- Advertisement
IC Document
Attachment 3- Screening Script.docx
Attachment 3- Screening Script
IC Document
Attachment 4 - Informed Consent.docx
Attachment 4 - Informed Consent
IC Document
Attachment 5- Thank You Letter.docx
Attachment 5- Thank You Letter
IC Document
Attachment 6-Data Retention Policy.docx
Attachment 6-Data Retention Policy
IC Document
Attachment 7 - NCHS Non-Disclosure Affidavit.docx
Attachment 7 - NCHS Non-Disclosure Affidavit
IC Document
Attachment 8 - NORC CIPESA Protection Plan.docx
Attachment 8 - NORC CIPESA Protection Plan
IC Document
SSA- RANDS 8.docx
SSA- RANDS 8
IC Document
SSB- RANDS 8.docx
SSB- RANDS 8
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
[NCHS] Collaborating Center For Questionnaire Design and Evaluation Research
Agency IC Tracking Number:
0920-0222-23EC
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
0920-0222-23EC
RANDS 8 Questionnaire
Attachment 1 -RANDS 8 Questionnaire.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:
16,600
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
16,600
0
16,600
0
0
0
Annual IC Time Burden (Hours)
4,150
0
4,150
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Attachment 2- Advertisement
Attachment 2- Advertisement.docx
04/12/2023
Attachment 3- Screening Script
Attachment 3- Screening Script.docx
04/12/2023
Attachment 4 - Informed Consent
Attachment 4 - Informed Consent.docx
04/12/2023
Attachment 5- Thank You Letter
Attachment 5- Thank You Letter.docx
04/12/2023
Attachment 6-Data Retention Policy
Attachment 6-Data Retention Policy.docx
04/12/2023
Attachment 7 - NCHS Non-Disclosure Affidavit
Attachment 7 - NCHS Non-Disclosure Affidavit.docx
04/12/2023
Attachment 8 - NORC CIPESA Protection Plan
Attachment 8 - NORC CIPESA Protection Plan.docx
04/12/2023
SSA- RANDS 8
SSA- RANDS 8.docx
04/12/2023
SSB- RANDS 8
SSB- RANDS 8.docx
04/12/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.