Information Collection

Cognitive Testing for the NSPCP

IC 198724 under ICR 201108-0920-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Cognitive Testing for the NSPCP	Form and Instruction
Cognitive Interview Intro and Guide: Survey Attachment 3a_ Cog Test Protocol 7-19-11.docx	Form and Instruction
Attachment 3b_Cog Testing Consent Form.docx Att 3b - Consent form	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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
Form and Instruction	none	Cognitive Interview Intro and Guide: Survey	Attachment 3a_ Cog Test Protocol 7-19-11.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 5

Number of Respondents for Small Entity: 3

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5	5
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 3b - Consent form	Attachment 3b_Cog Testing Consent Form.docx	07/25/2011

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