Information Collection

Cognitive Interview, Pretest, and Survey (Study 1)

IC 191569 under ICR 200912-0910-003 · OMB 0910-0655.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0655 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
symbol experiment Study 1 survey instrument Appendix G.doc	Other-survey
symbol experiment Study 1 eye tracking survey instrument Appendix H.doc	Other-survey
symbol experiment study 1 cognitive interview screener (appendix M) 120909.doc	Other-cognitive interview screener
symbol experiment study 1 symbols.doc symbol experiment study 1 symbols	IC Document
symbol experiment Study 1 reminder appendix K.doc symbol experiment Study 1 reminder appendix K	IC Document
symbol experiment Study 1 eye tracking invitation Appendix E.doc symbol experiment Study 1 eye tracking invitation Appendix E	IC Document

IC Title:

Cognitive Interview, Pretest, and Survey (Study 1)

Agency IC Tracking Number:

Is this a Common Form?

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-survey	symbol experiment Study 1 survey instrument Appendix G.doc	Yes	Yes	Fillable Fileable
Other-survey	symbol experiment Study 1 eye tracking survey instrument Appendix H.doc	Yes	Yes	Fillable Fileable
Other-cognitive interview screener	symbol experiment study 1 cognitive interview screener (appendix M) 120909.doc	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 14,784

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	14,784	14,784
Annual IC Time Burden (Hours)	1,427	1,427
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
symbol experiment study 1 symbols	symbol experiment study 1 symbols.doc	12/09/2009
symbol experiment Study 1 reminder appendix K	symbol experiment Study 1 reminder appendix K.doc	12/09/2009
symbol experiment Study 1 eye tracking invitation Appendix E	symbol experiment Study 1 eye tracking invitation Appendix E.doc	12/09/2009

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