Information Collection

Cognitive Interview, Pretest, and Survey (Study 2)

IC 191570 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
symbol experiment study 1 and 2 cognitive interview screener (appendix M) 120909.doc Other-cognitive interview screener
symbol experiment Study 2 survey instrument (Appendix I.doc Other-survey
symbol experiment study 2 pretest and survey invitation (Appendix F).doc symbol experiment study 2 pretest and survey invitation (Appendix F) IC Document
symbol experiment study 2 reminder email (Appendix L).doc symbol experiment study 2 reminder email (Appendix L) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Cognitive Interview, Pretest, and Survey (Study 2)	Agency IC Tracking Number:

Is this a Common Form?		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-cognitive interview screener			symbol experiment study 1 and 2 cognitive interview screener (appendix M) 120909.doc		Yes	Yes	Fillable Fileable
Other-survey			symbol experiment Study 2 survey instrument (Appendix I.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: 27,344	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	27,344	27,344
Annual IC Time Burden (Hours)	2,186	2,186
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
symbol experiment study 2 pretest and survey invitation (Appendix F)	symbol experiment study 2 pretest and survey invitation (Appendix F).doc	12/09/2009
symbol experiment study 2 reminder email (Appendix L)	symbol experiment study 2 reminder email (Appendix L).doc	12/09/2009

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