NCHS Questionnaire Design Research Laboratory

Forms and Documents

Document Name	Status
Form No number 2010 NHIS Cancer Supplement Form	New
QDRL-OMB-10day surveillance Maps 021208-letter.doc Justification for No Material/Nonsubstantive Change	2008-02-13
QDRL-OMB-10day surveillance Maps 021208- Attach 2.doc Supplementary Document	2008-02-13

IC Document Collections

IC ID	Document Title	Status
187068	NCHS Questionnaire Design Research Laboratory - testing Washington Group International Disability Questions Other-Testing Instrument	New
186723	2010 NHIS Cancer Supplement Form	New
186719	Program for the International Assessment of Adult Competencies (PIACC) Other-Cognitive Interview	New
186711	Testing NHANES Sensitive Questions Using Audio CASI Other-Computer Assisted Questionnaire	New
184096	Questionnaire Design Research Laboratory - Surveillance Map Cognitive Testing Other-Map Assessment Tool	New

ICR Details

OMB Control No: 0920-0222	ICR Reference No: 200803-0920-002
Status: Historical Active	Previous ICR Reference No: 200802-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: NCHS Questionnaire Design Research Laboratory
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/21/2008
	Date Received in OIRA: 03/11/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2010	02/28/2010	02/28/2010
Responses	850	0	850
Time Burden (Hours)	600	0	600
Cost Burden (Dollars)	0	0	0

---

Abstract: This submission describes proposed activities of the NCHS Questionnaire Design Research Laboratory. This project will test and evaluate how various surveillance map formats (choropleth versus isopleth) affect the ability to extract information from the maps.

---

Authorizing Statute(s): US Code: 42 USC 242k Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 25590	05/01/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 66784	11/16/2006
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Questionnaire Design Research Laboratory - Surveillance Map Cognitive Testing
Program for the International Assessment of Adult Competencies (PIACC)
Testing NHANES Sensitive Questions Using Audio CASI
2010 NHIS Cancer Supplement	No number	2010 Cancer Supplement
NCHS Questionnaire Design Research Laboratory - testing Washington Group International Disability Questions

---

ICR Summary of Burden

	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	850	850	0	0	0	0
Annual Time Burden (Hours)	600	600	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $1,002,450

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 03/11/2008

---