[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research

Forms and Documents

Document Name	Status
Form 0920-0222 (25BG) [NCHS] 2024 NHIS Diabetes Form and Instruction	Unchanged
[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research - RANDS 11 Form and Instruction	Modified
Form 0920-24IT [NCHS] BMI Focus Groups Form	Unchanged
Form 0920-0222 CCQDER - Questions on Subjective Cognitive Decline Form and Instruction	Unchanged
Form 0920-0222 [NCHS] genIC Attention Deficient Hyperactivity Disorder Questions Form and Instruction	Unchanged
[NCHS] Point of Care Checklist Subproject 1: Conducting In-depth Interviews Among Those with Intellectual and Developmental Disabilities Form and Instruction	Unchanged
[NCHS] Evaluation of Revised Questions on Cannabis Use and Experiences Form and Instruction	Unchanged
Form 0920-0222 [NCHS] RANDS 10 and Accompanying Cognitive Interviews (24CL) Form	Unchanged
Form 0920-24BI [NCHS]CCQDER's NHANES Feeding Practices Form and Instruction	Unchanged
Form 0920-0222 [NCHS] CCQDER - NISVS Form and Instruction	Unchanged
Form 1 GenIC for CCQDER's RANDS 9 Form and Instruction	Unchanged
Form 0920-0222-23EQ [NCHS] COLLABORATING CENTER FOR QUESTIONNAIRE DESIGN AND EVALUATION RESEARCH Form and Instruction	Unchanged
[NCHS] CCQDER's Caregiver Form and Instruction	Unchanged
Form 0920-0222-23EC [NCHS] Collaborating Center For Questionnaire Design and Evaluation Research Form and Instruction	Unchanged
Change Request Memo - EO14168 - 0920-0222 (RANDS 11).docx Justification for No Material/Nonsubstantive Change	2025-04-22
Att B 60-Day Published FRN 9_30_2022.pdf Supplementary Document	2022-12-14
SSB_0222_12012022.docx Supporting Statement B	2022-12-02
SSA_0222-12012022.docx Supporting Statement A	2022-12-02
Att O Thank You Letter.docx Supplementary Document	2021-08-03
Att N Explain Cog Interview.docx Supplementary Document	2021-08-03
Att M Sample Resp Data Collect Sheet.docx Supplementary Document	2021-08-03
Att L Sample Advance Letter.docx Supplementary Document	2021-08-03
Att K Voice mail script.docx Supplementary Document	2021-08-03
Att J Sample newspaper adv.docx Supplementary Document	2021-08-03
Att I Sample flyer.docx Supplementary Document	2021-08-03
Att H-1&H-2 IRB Approval Documentation.docx Supplementary Document	2021-08-03
Att G Spec Consent Focus Group.docx Supplementary Document	2021-08-03
Att F Spec Consent Cog Int.docx Supplementary Document	2021-08-03
Att E Informed Consent.docx Supplementary Document	2021-08-03
Att D Screening Script.docx Supplementary Document	2021-08-03
Att C Nondisclosure Affidavit.docx Supplementary Document	2021-08-03
Att A Public Health Serv Act.docx Supplementary Document	2021-08-03

IC Document Collections

IC ID	Document Title	Status
272342	[NCHS] 2024 NHIS Diabetes Form and Instruction	Unchanged
272296	[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research - RANDS 11 Form and Instruction	Modified
271058	[NCHS] BMI Focus Groups Form	Unchanged
269389	CCQDER - Questions on Subjective Cognitive Decline Form and Instruction	Unchanged
266008	[NCHS] genIC Attention Deficient Hyperactivity Disorder Questions Form and Instruction	Unchanged
265792	[NCHS] Point of Care Checklist Subproject 1: Conducting In-depth Interviews Among Those with Intellectual and Developmental Disabilities Form and Instruction	Unchanged
264921	[NCHS] Evaluation of Revised Questions on Cannabis Use and Experiences Form and Instruction	Unchanged
264723	[NCHS] RANDS 10 and Accompanying Cognitive Interviews (24CL) Form	Unchanged
264394	[NCHS]CCQDER's NHANES Feeding Practices Form and Instruction	Unchanged
263924	[NCHS] CCQDER - NISVS Form and Instruction	Unchanged
262818	GenIC for CCQDER's RANDS 9 Form and Instruction	Unchanged
260045	[NCHS] COLLABORATING CENTER FOR QUESTIONNAIRE DESIGN AND EVALUATION RESEARCH Form and Instruction	Unchanged
260017	[NCHS] CCQDER's Caregiver Form and Instruction	Unchanged
259654	[NCHS] Collaborating Center For Questionnaire Design and Evaluation Research Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-0222	ICR Reference No: 202504-0920-019
Status: Received in OIRA	Previous ICR Reference No: 202212-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-25-0099
Title: [NCHS] Collaborating Center for Questionnaire Design and Evaluation Research
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 05/01/2025

	Requested	Previously Approved
Expiration Date	01/31/2026	01/31/2026
Responses	215,775	215,775
Time Burden (Hours)	65,715	65,715
Cost Burden (Dollars)	1,840,677	1,840,677

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Abstract: This generic clearance request encompasses general questionnaire development, pre-testing, measurement-error reduction activities to be carried out in 2021-2024 in the Division of Research and Methodology, National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC). The change request is for RANDS 11 to adhere to recent executive orders.

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

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 59425	09/30/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 76049	12/12/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 14

IC Title	Form No.	Form Name
CCQDER - Questions on Subjective Cognitive Decline	0920-0222, 0920-0222, 0920-0222	Cognitive Decline - Screening Script ,   Questions to be Cognitively Tested ,   Respondent Data Collection Sheet
GenIC for CCQDER's RANDS 9	1	qustionnaire
[NCHS] 2024 NHIS Diabetes	0920-0222 (25BG), 0920-0222 (25BG), 0920-0222 (25BG), 0920-0222 (25BG)	Focus Grouip Protocol ,   Focus Group Telephone Screening Script ,   Respondent Data Collection Sheet ,   Cognitive Interviewing Telephone Screening Script
[NCHS] BMI Focus Groups	0920-24IT, 0920-24IT	Respondent Data Collection ,   Respondent Informed Consent
[NCHS] CCQDER - NISVS	0920-0222, 0920-0222, 0920-0222	NISVS Screener ,   NISVS Questionnaire ,   {NISVS] Respondent Data Collection Sheet (No Form)
[NCHS] CCQDER's Caregiver	n/a, n/a, n/a	Caregiving Questions ,   Caregiving Screening Script ,   Respondent Data Collection Sheet
[NCHS] COLLABORATING CENTER FOR QUESTIONNAIRE DESIGN AND EVALUATION RESEARCH	0920-0222-23EQ, 0920- 0222-23EQ, 0920-0222-23EQ	Attachment 5a-5b Respondent Data Collection Sheet 4.28.23 ,   Questions ,   Screening Script
[NCHS] Collaborating Center For Questionnaire Design and Evaluation Research	0920-0222-23EC	RANDS 8 Questionnaire
[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research - RANDS 11	n/a	RANDS 11 Questionnaire-12.10.2024
[NCHS] Evaluation of Revised Questions on Cannabis Use and Experiences	n/a, n/a, n/a	Cannabis Questions to be Cognitively Tested ,   Cannabis Screening Script ,   Cannabis Data Collection Sheet
[NCHS] Point of Care Checklist Subproject 1: Conducting In-depth Interviews Among Those with Intellectual and Developmental Disabilities	n/a, n/a, n/a	Telephone Screening Script ,   Interviewer's Guide ,   Data Collection Sheets
[NCHS] RANDS 10 and Accompanying Cognitive Interviews (24CL)	0920-0222, 0920-022 (24CL), 0920-0222 (24CL)	CCQDER RANDS 10 Questionnaire ,   Telephone Screening Script ,   Respondent Data Collection Sheet
[NCHS] genIC Attention Deficient Hyperactivity Disorder Questions	0920-0222, 0920-0222, 0920-0222	Attachment 6 Respondent Data Collection Sheet ,   ADHD Attachment 1 Questions to be tested ,   Attachment 5 Informed Consent ADHD
[NCHS]CCQDER's NHANES Feeding Practices	0920-24BI, 0920-24BI, 0920-24BI, 0920-24BI, 0920-24BI, 0920-24BI	Attachment 1a-NHANES Question Set 1 11.16.23 CLEAN ,   Attachment 1b-NHANES Question Set 2 11.22.23 CLEAN ,   Attachment 4a - Screening script NHANES 11.16.23 CLEAN ,   Attachment 4b- Screening script NHANES 11.16.23 CLEAN ,   Attachment 5a & 5b - Informed Consent NHANES 11.16.23 ,   Attachment 3a- NHANES English Advertisement

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ICR Summary of Burden

	Total Request	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	215,775	215,775	0	0	0	0
Annual Time Burden (Hours)	65,715	65,715	0	0	0	0
Annual Cost Burden (Dollars)	1,840,677	1,840,677	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: Revision for 0920-0222 requests an increase in burden hours for the next 3-year approval period due to an anticipated increase in the number of RANDS Methodological projects during the approval period.

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Annual Cost to Federal Government: $3,223,325

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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: 05/01/2025

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