Conduct Cognitive Testing of Test Survey Questions

Comprehensive Communication Campaign for HITECH ACT

Documents and Forms

Document Name Document Type
0990-0376_Attachment 1 Consumer Privacy Security Cognitive Recruitment Screener.docx Other-testing
0990-0376_Attachment 2 Consumer Privacy Security Cognitive Interview Protocol.docx Other-testing
0990-0376_Attachement 3 Consumer Privacy Security Survey Questions.docx Other-testing
0990-0376_Attachment 4 Consumer Privacy Security Spanish Cognitive Recruitment Screener.doc Other-test
0990-0376_Attachment 6 Consumer Privacy Security Spanish Survey Questions Main.docx Other-test
0990-0376_Attachment 5 Consumer Privacy Security Spanish Cognitive Interview Protocol.docx 0990-0376_Attachment 5 Consumer Privacy Security Spanish Cognitive Interview Protocol IC Document
0990-0376_Mini Supporting Statement Cognitive Testing Consumer Privacy Security.docx 0990-0376_Mini Supporting Statement Cognitive Testing Consumer Privacy Security IC Document

Information Collection (IC) Details

IC Title:	Conduct Cognitive Testing of Test Survey Questions	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-testing	0990-0376_Attachment 1 Consumer Privacy Security Cognitive Recruitment Screener.docx	Yes	Yes	Fillable Printable
Other-testing	0990-0376_Attachment 2 Consumer Privacy Security Cognitive Interview Protocol.docx	Yes	Yes	Printable Only
Other-testing	0990-0376_Attachement 3 Consumer Privacy Security Survey Questions.docx	Yes	Yes	Printable Only
Other-test	0990-0376_Attachment 4 Consumer Privacy Security Spanish Cognitive Recruitment Screener.doc	Yes	Yes	Printable Only
Other-test	0990-0376_Attachment 6 Consumer Privacy Security Spanish Survey Questions Main.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	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	25	0	0	0	0	0
Annual IC Time Burden (Hours)	38	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
0990-0376_Attachment 5 Consumer Privacy Security Spanish Cognitive Interview Protocol	0990-0376_Attachment 5 Consumer Privacy Security Spanish Cognitive Interview Protocol.docx	11/30/2011
0990-0376_Mini Supporting Statement Cognitive Testing Consumer Privacy Security	0990-0376_Mini Supporting Statement Cognitive Testing Consumer Privacy Security.docx	11/30/2011

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