Generic Sub-study: Reliability Testing for Survey Questions about the Walking Environment

Questionnaire Cognitive Interviewing and Pretesting (NCI)

Documents and Forms

Document Name Document Type
Form 1 Generic Sub-study: Reliability Testing for Survey Questions about the Walking Environment Form and Instruction
1 Appendix A Final Walking Environment First Appendix A Final Walking Environment First.pdf Form and Instruction
2 Appendix B Final Walking Behaviors First Appendix B Final Walking Behaviors First.pdf Form and Instruction
3 Appendix C Final Random Order Appendix C Final Random Order.pdf Form and Instruction
4 Appendix D Final Cognitive Probes Appendix D Final Cognitive Probes.pdf Form and Instruction
NCI Mini SSB Final.docx Mini SSB IC Document
NCI Mini SSA Final KB-1.docx Mini SSA IC Document

Information Collection (IC) Details

IC Title:	Generic Sub-study: Reliability Testing for Survey Questions about the Walking Environment	Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Appendix A Final Walking Environment First	Appendix A Final Walking Environment First.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	2	Appendix B Final Walking Behaviors First	Appendix B Final Walking Behaviors First.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	3	Appendix C Final Random Order	Appendix C Final Random Order.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	4	Appendix D Final Cognitive Probes	Appendix D Final Cognitive Probes.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	274	274
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Mini SSB	NCI Mini SSB Final.docx	02/23/2015
Mini SSA	NCI Mini SSA Final KB-1.docx	02/24/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.