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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.