Information Collection

Questionnaire Design Research Laboratory - Surveillance Map Cognitive Testing

IC 184096 under ICR 200803-0920-002 · OMB 0920-0222.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
QDRL-OMB-10day surveillancef Maps 0108- Attach 1.doc	Other-Map Assessment Tool
QDRL-OMB-10day surveillance Maps 021208- Attach 2.doc Advertisement	IC Document

IC Title:

Questionnaire Design Research Laboratory - Surveillance Map Cognitive Testing

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Map Assessment Tool			QDRL-OMB-10day surveillancef Maps 0108- Attach 1.doc		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population

FR Citation: 49 FR 37693

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	30	0	0	0	0	0
Annual IC Time Burden (Hours)	30	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Advertisement	QDRL-OMB-10day surveillance Maps 021208- Attach 2.doc	02/13/2008

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