Generic Clearence for Questionnaire Pretesting Research

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DY-1(X) Census 2010	Form	New	Available
Form DD-1302 (CFU) Coverage Followup Questionnaire	Form	New	Available
Form NMACS-100(ASC) National Hospital Ambulatory Medical Care Survey -- 2009 Ambulatory Surgery Center Patient Record Folio	Form	New	Available
Form NMACS-101(U) Ambulatory Unit Record, National Hospital Ambulatory Medical Care Survey -- 2009 Panel	Form	New	Available
Form NHAMCS-101(C) National Hospital Ambulatory Medical Care Survey -- 2009 Panel Control Card	Form	New	Available
Form NHAMCS-101 National Hospital AmbulatoryMedical Care Survey -- 2009 Panel	Form	New	Available
Form D-15 Census 2010 Transitory Location Questionnaire	Form	New	Available
Form BRD-1 2008 Business Research & Development Survey	Form	New	Available
Form SCS-1 School Crime Supplement to the NCVS	Form	New	Available
Form Satisfaction Quest Satisfaction Questionnaire	Form	New	Available
Form DY-1(E) Census 2010 Enumerator Questionnaire	Form	New	Available
Form OUNCE-C One-Unit Nonconstruction Cost Evaluation	Form	New	Available
Form OUNCE-S One-Unit Nonconstruction Cost Evaluation	Form	New	Available
Form QFR-300(S) Quarterly Financial Report	Form	New	Available
Form BRDS Financial Mod BRDS Financial Module	Form	New	Available
Form BRDS Intellectual BRDS Intellectual Property Section	Form	New	Available
Form BRDS Human Resourc BRDS Human Resources Module	Form	New	Available
Form Respondent Debrief Respondent Debriefing Questions	Form	New	Available
Form EHC Event History Calendar questions	Form	New	Available
Form M-3DOD Manufacturers' Shipments, Inventories, and Orders (M3) To The Department of Defense Supplement: 2006-2007	Form	New	Available
Form SA-42(AGBR) Annual Wholesale Trade Report, Agents, Brokers, and Electronic Markets	Form	New	Available
Form NCVS-1 National Crime Victimization Survey	Form	New	Available
Form NCVS Internet Pred NCVS Internet Predation Questions	Form	New	Available
Survey of Industrial R&D (Manager Section)	Form	New	Available
Survey of Industrial R&D (Personnel Section)	Form	New	Available
Form D-1(TEST) 2008 Census Test	Form	New	Available
Form DX-10 2008 Census Dress Rehearsal Be Counted Form	Form	New	Available
Form SBO-1 (Internet Re Survey of Business Owners and Self-Employed Persons	Form	New	Available
Form DX-1302 Listing Page 3	Form	New	Available
Form DX-1302 Listing Page 2	Form	New	Available
Form DX-1302 Listing Page 1	Form	New	Available
Form VCE-1 VCE Cognitive Testing -- Version A	Form	New	Available
Form VCE-2 VCE Cognitive Testing -- Version B	Form	New	Available
07genclrusabilityconsentforms.wpd	Supplementary Document	Uploaded 2007-05-16	Available
07genclreconconsentform.wpd	Supplementary Document	Uploaded 2007-05-16	Available
07genclrdemoconsentforms.wpd	Supplementary Document	Uploaded 2007-05-16	Available
07genclrattachment A.wpd	Supplementary Document	Uploaded 2007-04-24	Available
07genclrpartB.wpd	Supporting Statement B	Uploaded 2007-04-24	Available
07genclrpartA.wpd	Supporting Statement A	Uploaded 2007-08-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
186835	Testing of: NHAMCS, NAMCS, 2010 "Itsinourhands" web site, 2010 CFU, 2010 ACS, and 2010 Mailout Materials	Form	New	Census 2010
186835	Testing of: NHAMCS, NAMCS, 2010 "Itsinourhands" web site, 2010 CFU, 2010 ACS, and 2010 Mailout Materials	Form	New	Coverage Followup Questionnaire
186835	Testing of: NHAMCS, NAMCS, 2010 "Itsinourhands" web site, 2010 CFU, 2010 ACS, and 2010 Mailout Materials	Form	New	National Hospital Ambulatory Medical Care Survey -- 2009 Ambulatory Surgery Center Patient Record Folio
186835	Testing of: NHAMCS, NAMCS, 2010 "Itsinourhands" web site, 2010 CFU, 2010 ACS, and 2010 Mailout Materials	Form	New	Ambulatory Unit Record, National Hospital Ambulatory Medical Care Survey -- 2009 Panel
186835	Testing of: NHAMCS, NAMCS, 2010 "Itsinourhands" web site, 2010 CFU, 2010 ACS, and 2010 Mailout Materials	Form	New	National Hospital Ambulatory Medical Care Survey -- 2009 Panel Control Card
186835	Testing of: NHAMCS, NAMCS, 2010 "Itsinourhands" web site, 2010 CFU, 2010 ACS, and 2010 Mailout Materials	Form	New	National Hospital AmbulatoryMedical Care Survey -- 2009 Panel
186835	Testing of: NHAMCS, NAMCS, 2010 "Itsinourhands" web site, 2010 CFU, 2010 ACS, and 2010 Mailout Materials	Other-NHMACS Draft ASC Respondent Debriefing	New
186680	Field Test of the 2010 Census Enumeration of Transitory Locations (ETL) Questionnaire	Other-Handout & Flashcard Lists	New
186680	Field Test of the 2010 Census Enumeration of Transitory Locations (ETL) Questionnaire	Form	New	Census 2010 Transitory Location Questionnaire
186412	Business Research and Development Survey Additional In-depth Interviews	Form	New	2008 Business Research & Development Survey
186194	Cognitive Research on the National Crime Victimization Survey, School Crime Supplement	Other-Consent Form	New
186194	Cognitive Research on the National Crime Victimization Survey, School Crime Supplement	Form	New	School Crime Supplement to the NCVS
186079	Cognitive & Usability Testing of the 2010 Enumerator Questionnaire	Form	New	Satisfaction Questionnaire
186079	Cognitive & Usability Testing of the 2010 Enumerator Questionnaire	Other-Information Sheet	New
186079	Cognitive & Usability Testing of the 2010 Enumerator Questionnaire	Form	New	Census 2010 Enumerator Questionnaire
185953	Debriefing Interviews for Survey of Construction, One-Unit Nonconstruction Cost Evaluation (OUNCE)	Form	New	One-Unit Nonconstruction Cost Evaluation
185953	Debriefing Interviews for Survey of Construction, One-Unit Nonconstruction Cost Evaluation (OUNCE)	Form	New	One-Unit Nonconstruction Cost Evaluation
185586	Research on Alternative Methods of Collecting Think-Aloud Protocols	Other-Proposed Tasks for Study	New
185452	Cognitive Interviews for the Quarterly Financial Report	Form	New	Quarterly Financial Report
185362	Respondent Debriefings for SURVEYOR Electronic Data Collection Tool in 2007 Economic Census	Other-SURVEYOR Screen Shots	New
184916	Cognitive Interviews to Evaluate Segments of the 2009 AHS Spanish Version	Other-Phase 1 (English)	New
184835	Cognitive Research on Experimental CPS Health Insurance Questions	Other-Experimental CPS Health Insurance Questions	New
184615	In -depth interviews to support development of a redesigned Survey of Industrial Research & Development	Form	New	BRDS Financial Module
184615	In -depth interviews to support development of a redesigned Survey of Industrial Research & Development	Form	New	BRDS Intellectual Property Section
184615	In -depth interviews to support development of a redesigned Survey of Industrial Research & Development	Form	New	BRDS Human Resources Module
184377	Field Test of Survey of Income & Program Participation, Event History Calendar	Form	New	Respondent Debriefing Questions
184377	Field Test of Survey of Income & Program Participation, Event History Calendar	Form	New	Event History Calendar questions
184377	Field Test of Survey of Income & Program Participation, Event History Calendar	Other-Control Card	New
184353	Cognitive Interviews for M3, Department of Defense	Form	New	Manufacturers' Shipments, Inventories, and Orders (M3) To The Department of Defense Supplement: 2006-2007
184201	Cognitive Interviews for the Annual Wholesale Trade Report, Agents, Broker, and Electronic Markets Form	Form	New	Annual Wholesale Trade Report, Agents, Brokers, and Electronic Markets
184155	Pretesting of Services Annual Survey, Internet Reporting Application	Other-Various Screen Shots from SAS Internet Application	New
183966	Cognitive Research on the National Crime Victimization Survey, Internet Predation Questions	Form	New	National Crime Victimization Survey
183966	Cognitive Research on the National Crime Victimization Survey, Internet Predation Questions	Form	New	NCVS Internet Predation Questions
183966	Cognitive Research on the National Crime Victimization Survey, Internet Predation Questions	Other-Consent Form	New
183912	Focus Groups to Develop Messages for the Census 2010 Public Information Campaign, Phase II	Other-moderators guide	New
183736	Pretesting of Redesigned Survey of Industrial Research & Development	Form	New	Survey of Industrial R&D (Manager Section)
183736	Pretesting of Redesigned Survey of Industrial Research & Development	Form	New	Survey of Industrial R&D (Personnel Section)
183596	Pretesting of CPS Unbanked & Underbanked Supplement	Other-Unbanked & Underbanked Questions	New
183516	Testing of American Community Survey Translations	Other-Introductory Letter	New
183260	2010 Census Questionnaire Language Testing	Form	New	2008 Census Test
183215	Research on VCE Supplement to the CPS	Other-Version A -- VCE Questions	New
182916	Cognitive Interviews for Spanish ACS CATI/CAPI Version	Other-First Segment of ACS Questions to be Tested	New
182831	Cognitive Testing of the 2008 Be Counted Questionnaire	Form	New	2008 Census Dress Rehearsal Be Counted Form
182598	Focus Groups to Identify Issues & Obstacles to Responding to the Census	Other-PHASE 2 Discussion Outline (Creative Development)	New
182410	Usability Testing of SBO Internet Reporting Application	Form	New	Survey of Business Owners and Self-Employed Persons
182344	Respondent Debriefings for CCM Independent Listing Book	Form	New	Listing Page 3
182344	Respondent Debriefings for CCM Independent Listing Book	Form	New	Listing Page 2
182344	Respondent Debriefings for CCM Independent Listing Book	Form	New	Listing Page 1
181951	Pretesting of Respondent Letters for the Survey of Industrial Research & Development	Other-SIRD - Pre-survey Notice Letter	New
181668	Cognitive Testing of ACS Postcards & Cover Letter	Other-ACS Revised Reminder Postcards & Letter for Testing	New
181542	Research on the proposed Voting and Civic Engagement (VCE) supplement to the Current Population Survey	Form	New	VCE Cognitive Testing -- Version A
181542	Research on the proposed Voting and Civic Engagement (VCE) supplement to the Current Population Survey	Form	New	VCE Cognitive Testing -- Version B

ICR Details

OMB Control No: 0607-0725	ICR Reference No: 200704-0607-002
Status: Historical Active	Previous ICR Reference No: 200407-0607-001
Agency/Subagency: DOC/CENSUS	Agency Tracking No:
Title: Generic Clearence for Questionnaire Pretesting Research
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/07/2007
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/08/2007
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2010	36 Months From Approved	08/31/2007
Responses	5,500	0	5,500
Time Burden (Hours)	5,500	0	5,500
Cost Burden (Dollars)	0	0	0

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Abstract: The research will be used by the Census Bureau and the survey sponsors to improve questionnaires and procedures, reduce respondent burden, and ultimately increase the quality of data collected in Census Bureau censuses and surveys.

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Authorizing Statute(s): US Code: 13 USC 131, 141, 161, 181, 182, 193,
  

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:
	72 FR 8963	02/28/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 31808	06/08/2007
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 31

table that charts list of burden

IC Title	Form No.	Form Name
2010 Census Questionnaire Language Testing	D-1(TEST)	2008 Census Test
Business Research and Development Survey Additional In-depth Interviews	BRD-1	2008 Business Research & Development Survey
Cognitive & Usability Testing of the 2010 Enumerator Questionnaire	DY-1(E), Satisfaction Questionnaire	Census 2010 Enumerator Questionnaire ,   Satisfaction Questionnaire
Cognitive Interviews for M3, Department of Defense	M-3DOD	Manufacturers' Shipments, Inventories, and Orders (M3) To The Department of Defense Supplement: 2006-2007
Cognitive Interviews for Spanish ACS CATI/CAPI Version
Cognitive Interviews for the Annual Wholesale Trade Report, Agents, Broker, and Electronic Markets Form	SA-42(AGBR)	Annual Wholesale Trade Report, Agents, Brokers, and Electronic Markets
Cognitive Interviews for the Quarterly Financial Report	QFR-300(S)	Quarterly Financial Report
Cognitive Interviews to Evaluate Segments of the 2009 AHS Spanish Version
Cognitive Research on Experimental CPS Health Insurance Questions
Cognitive Research on the National Crime Victimization Survey, Internet Predation Questions	NCVS-1, NCVS Internet Predation Questions	NCVS Internet Predation Questions ,   National Crime Victimization Survey
Cognitive Research on the National Crime Victimization Survey, School Crime Supplement	SCS-1	School Crime Supplement to the NCVS
Cognitive Testing of ACS Postcards & Cover Letter
Cognitive Testing of the 2008 Be Counted Questionnaire	DX-10	2008 Census Dress Rehearsal Be Counted Form
Debriefing Interviews for Survey of Construction, One-Unit Nonconstruction Cost Evaluation (OUNCE)	OUNCE-C, OUNCE-S	One-Unit Nonconstruction Cost Evaluation ,   One-Unit Nonconstruction Cost Evaluation
Field Test of Survey of Income & Program Participation, Event History Calendar	Respondent Debriefing Questions, EHC	Event History Calendar questions ,   Respondent Debriefing Questions
Field Test of the 2010 Census Enumeration of Transitory Locations (ETL) Questionnaire	D-15	Census 2010 Transitory Location Questionnaire
Focus Groups to Develop Messages for the Census 2010 Public Information Campaign, Phase II
Focus Groups to Identify Issues & Obstacles to Responding to the Census
In -depth interviews to support development of a redesigned Survey of Industrial Research & Development	BRDS Human Resources Module, BRDS Intellectual Property Section, BRDS Financial Module	BRDS Intellectual Property Section ,   BRDS Financial Module ,   BRDS Human Resources Module
Pretesting of CPS Unbanked & Underbanked Supplement
Pretesting of Redesigned Survey of Industrial Research & Development	none, none	Survey of Industrial R&D (Personnel Section) ,   Survey of Industrial R&D (Manager Section)
Pretesting of Respondent Letters for the Survey of Industrial Research & Development
Pretesting of Services Annual Survey, Internet Reporting Application
Research on Alternative Methods of Collecting Think-Aloud Protocols
Research on VCE Supplement to the CPS
Research on the proposed Voting and Civic Engagement (VCE) supplement to the Current Population Survey	VCE-1, VCE-2	VCE Cognitive Testing -- Version A ,   VCE Cognitive Testing -- Version B
Respondent Debriefings for CCM Independent Listing Book	DX-1302, DX-1302, DX-1302	Listing Page 1 ,   Listing Page 2 ,   Listing Page 3
Respondent Debriefings for SURVEYOR Electronic Data Collection Tool in 2007 Economic Census
Testing of American Community Survey Translations
Testing of: NHAMCS, NAMCS, 2010 "Itsinourhands" web site, 2010 CFU, 2010 ACS, and 2010 Mailout Materials	NMACS-100(ASC), DD-1302 (CFU), DY-1(X), NHAMCS-101(C), NMACS-101(U), NHAMCS-101	National Hospital AmbulatoryMedical Care Survey -- 2009 Panel ,   National Hospital Ambulatory Medical Care Survey -- 2009 Panel Control Card ,   Ambulatory Unit Record, National Hospital Ambulatory Medical Care Survey -- 2009 Panel ,   National Hospital Ambulatory Medical Care Survey -- 2009 Ambulatory Surgery Center Patient Record Folio ,   Coverage Followup Questionnaire ,   Census 2010
Usability Testing of SBO Internet Reporting Application	SBO-1 (Internet Reporting Application)	Survey of Business Owners and Self-Employed Persons

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ICR Summary of Burden

table that charts list 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	5,500	5,500	0	0	0	0
Annual Time Burden (Hours)	5,500	5,500	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:

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Annual Cost to Federal Government: $0

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

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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: 06/08/2007

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