OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

NCHS Questionnaire Design Research Laboratory

ICR 201205-0920-001 · OMB 0920-0222 · Historical Active

Forms and Documents
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Supporting Statement B
2012-05-08
Supplementary Document
2012-05-08
Supplementary Document
2012-05-08
Supplementary Document
2012-05-08
Supplementary Document
2012-05-08
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2012-05-08
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2012-05-08
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2012-05-08
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2012-05-08
Supporting Statement A
2012-05-08
IC Document Collections
IC ID
Document
Title
Status
216469 New
215959 New
215946 New
215509 New
215492 New
215142 New
214970 New
214369 New
212592 New
211558 New
211406 New
210607 New
209941 New
208996 New
207913 New
207399 New
204892 New
203563 New
203170 New
202862 New
ICR Details
0920-0222 201205-0920-001
Historical Active 201002-0920-006
HHS/CDC
NCHS Questionnaire Design Research Laboratory
Revision of a currently approved collection   No
Regular
Approved without change 06/13/2012
Retrieve Notice of Action (NOA) 05/10/2012
CDC will continue to submit individual collections under this generic clearance to OMB. OMB will strive to provide feedback on the individual collections within ten working days, whenever possible, as is currently the case. Standard remuneration of respondents for congantive testing is $40.00. Higher remunerations may be requested with justification for difficult recruitments, focus groups, etc.
  Inventory as of this Action Requested Previously Approved
06/30/2015 36 Months From Approved 03/31/2013
9,300 0 850
9,450 0 1,800
0 0 0
This submission describes proposed research activities of the National Center for Health Statistics (NCHS) Questionnaire Design Research Laboratory. Survey specific research activities include questionnaire development, pre-testing, and evaluation activities for NCHS, CDC, other federal agencies, or other academic or professional institutions. The purpose and use of collecting this information fall into five categories: 1) Development and testing of specific survey questionnaires; 2) Research on the cognitive and interpretive aspects of survey methodology; 3) Research on human-computer interfaces/usability; 4) Field tests/Pilot interviewing; and 5) Studies of the optimal design and presentation of statistical graphical and textual material. Methods for data collection include interviewer administered, self-administered, telephone, Computer Assisted Personal Interviewing (CAPI) and Computer Assisted Self-Interviewing (CASI), Audio Computer-Assisted Self-Interviewing (ACASI), and web-based questionnaires including: cognitive interviewing, focus groups, usability testing, and field tests/pilot household interviews.
US Code: 42 USC 242k Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  77 FR 11124 02/24/2012
77 FR 27064 05/08/2012
Yes
20
IC Title Form No. Form Name
Evaluation of Uniform Donor History Questionnaire and Evaluation of Violence Against Children Survey (VACS)- Malawi None, None, None Attachment 1 Uniform Donor History Questionnaire ,   What to do when a loved one dies-A survivor's checklist ,   Attachment 1: Violence Against Children Survey - Malawi: Age 13-24 years
4 Sets of Health Questions and Blood Donor History Questionnaire Evaluation none, none Four Sets of Health Related Questions ,   Blood Donor History Questionnaire
Cognitive Testing of Adults with Chronic Health Care Needs none Adults with Chronic Health Care Needs
Evaluate Cervical and Lung Cancer Screening Questions none, none Screener ,   Questionnaire
Cognitive testing of High-impact, Chronic Pain questions - NCHS Questionnaire Design Research Laboratory (QDRL) None, None Telephone Screener ,   Pain Questionnaire to be evaluated
2015 NHIS Occupational Health Supplement and Cancer Control Supplement none, none Cancer Control - Questionniare ,   Cancer Control - screener
Testing Long-term Care Questions none, none, none NSLTP - Adult Day Services Center ,   NSLTP - Residential Care Community ,   Screeners
Violence Against Children Survey Evaluation Study - Philippines none Violence Against Children Survey
2013 NHIS Health Insurance Web and Cognitive Interview Study none, 4 Questionnaire ,   Screener
NAMCS Feasibility Study none, none, none Physician Survey ,   Medical Organization Survey ,   Phys and Organization Survey
GENERIC IC Gen IC Questionnaire Design Research Lab - 2013 Comparative Disability Questions and Mode Effects Study None, None, None Attachment 1a: WHO Questionnaire ,   Attachment 1b: Washington Group Questionnaire ,   Attachments 3a & 3b--Telephone Screeners
Adult and Child Disability Questions none, none, none Screening Script ,   Adult Disability Questions ,   Child Disability Questions
UNICEF/Washington Group School Environment Study none, none Questionnaire ,   Screener
NHIS College Housing Frame Questionnaire Study
Questionnaire Design Research Lab: 5600 Case CAPI and ACASI NHIS Field Test none, none Proposed ACASI Questions ,   HIS-100C, January 2011 Manual for NHIS Field Reps Explaning the Survey
Questionnaire Design Research Lab (2016 NAMCS Culturally and Linguistically Appropriate Services (CLAS) Supplement Evaluation) 0920-0222, 0920-0222 Attach 1 Q8 050615 (2) ,   Attach 3 - CLAS Phone screener
Teen Disability and Demographic Questions Cognitive Interviewing Study none, none Questionnaire ,   Screener
Diabetes Primary Prevention none, none Questionnaire ,   Screener
2015 National Electronic Health Records Survey none, none, none National Electronic Health Records Survey 2015 ,   Screener ,   Respondent Data Sheet
Pregnancy Risk Assessment Monitoring System none, none, none, none PRAMS Phase 8 ,   Screener ,   Consent ,   Respondent Data
  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 9,300 850 0 0 8,450 0
Annual Time Burden (Hours) 9,450 1,800 0 0 7,650 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$1,571,700
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Petunia Gissendaner 4046390164
  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.
05/10/2012