Information Collection

Bundled Sub-studies #20, #21 and #22 Website Usability Testing

IC 205388 under ICR 201108-0925-002 · OMB 0925-0642.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0642 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Bundled Sub-studies #20, #21 and #22 Website Usability Testing	Form and Instruction
1 CPCC #20 Screener CPCC_#20_Attach2 Recruitment Screener.docx	Form and Instruction
2 CPCC #20 Facilitator's Guide CPCC_#20_Attach5 Facilitator's Guide Final.doc	Form and Instruction
3 DCPDIV #21 Screener DCP Div_#21_Attach2 Recruitment Screener.docx	Form and Instruction
4 DCPDIV #21 Facilitator's Guide DCP Div_#21_Attach3 Facilitator's Guide.doc	Form and Instruction
5 DCP NSRG Screener DCP NSRG_#22_Attach2 Recruitment Screener.docx	Form and Instruction
6 DCP NSRG Facilitator's Guide DCP NSRG_#22_Attach3 Facilitator's Guide.doc	Form and Instruction
CPCC_Fast-Track_Request #20.doc CPCC_Fast-Track_Request #20	IC Document
Memo to OMB_Key To Fast Track Bundle_#20-22.doc Memo to OMB_Key To Fast Track Bundle_#20-22	IC Document
CPCC_#20_Attach1 Email for Participant Request .docx CPCC_#20_Attach1 Email for Participant Request	IC Document
CPCC_#20_Attach3 Remote Consent Script.doc CPCC_#20_Attach3 Remote Consent Script	IC Document
CPCC_#20_Attach4 In-lab Consent Form.doc CPCC_#20_Attach4 In-lab Consent Form	IC Document
DCP Div Fast-Track_Request #21.doc DCP Div Fast-Track_Request #21	IC Document
DCP Div_#21_Attach1 Recruit E-mail.docx DCP Div_#21_Attach1 Recruit E-mail	IC Document
DCP Div_#21_Attach4 Informed Consent Form.docx DCP Div_#21_Attach4 Informed Consent Form	IC Document
DCP Div_#21_Attach5 Script Verbal Consent.docx DCP Div_#21_Attach5 Script Verbal Consent	IC Document
DCP NSRG Fast-Track Request #22.doc DCP NSRG Fast-Track Request #22	IC Document
DCP NSRG_#22_Attach1 Recruit E-mail.docx DCP NSRG_#22_Attach1 Recruit E-mail	IC Document
DCP NSRG_#22_Attach4 Informed Consent Form.docx DCP NSRG_#22_Attach4 Informed Consent Form	IC Document
DCP NSRG_#22_Attach5 Script for Verbal Informed Consent for Remote Participants.docx DCP NSRG_#22_Attach5 Script for Verbal Informed Consent for Remote Participants	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Bundled Sub-studies #20, #21 and #22 Website Usability Testing

Agency IC Tracking Number:

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	CPCC #20 Screener	CPCC_#20_Attach2 Recruitment Screener.docx	Yes	No	Printable Only
Form and Instruction	2	CPCC #20 Facilitator's Guide	CPCC_#20_Attach5 Facilitator's Guide Final.doc	Yes	No	Printable Only
Form and Instruction	3	DCPDIV #21 Screener	DCP Div_#21_Attach2 Recruitment Screener.docx	Yes	No	Printable Only
Form and Instruction	4	DCPDIV #21 Facilitator's Guide	DCP Div_#21_Attach3 Facilitator's Guide.doc	Yes	No	Printable Only
Form and Instruction	5	DCP NSRG Screener	DCP NSRG_#22_Attach2 Recruitment Screener.docx	Yes	No	Printable Only
Form and Instruction	6	DCP NSRG Facilitator's Guide	DCP NSRG_#22_Attach3 Facilitator's Guide.doc	Yes	No	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: SORN #09-25-0156, "Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD"

FR Citation: 67 FR 60743

Number of Respondents: 132

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	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	132	0	0	0	0	0
Annual IC Time Burden (Hours)	72	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CPCC_Fast-Track_Request #20	CPCC_Fast-Track_Request #20.doc	01/10/2013
Memo to OMB_Key To Fast Track Bundle_#20-22	Memo to OMB_Key To Fast Track Bundle_#20-22.doc	01/10/2013
CPCC_#20_Attach1 Email for Participant Request	CPCC_#20_Attach1 Email for Participant Request .docx	01/10/2013
CPCC_#20_Attach3 Remote Consent Script	CPCC_#20_Attach3 Remote Consent Script.doc	01/10/2013
CPCC_#20_Attach4 In-lab Consent Form	CPCC_#20_Attach4 In-lab Consent Form.doc	01/10/2013
DCP Div Fast-Track_Request #21	DCP Div Fast-Track_Request #21.doc	01/10/2013
DCP Div_#21_Attach1 Recruit E-mail	DCP Div_#21_Attach1 Recruit E-mail.docx	01/10/2013
DCP Div_#21_Attach4 Informed Consent Form	DCP Div_#21_Attach4 Informed Consent Form.docx	01/10/2013
DCP Div_#21_Attach5 Script Verbal Consent	DCP Div_#21_Attach5 Script Verbal Consent.docx	01/10/2013
DCP NSRG Fast-Track Request #22	DCP NSRG Fast-Track Request #22.doc	01/10/2013
DCP NSRG_#22_Attach1 Recruit E-mail	DCP NSRG_#22_Attach1 Recruit E-mail.docx	01/10/2013
DCP NSRG_#22_Attach4 Informed Consent Form	DCP NSRG_#22_Attach4 Informed Consent Form.docx	01/10/2013
DCP NSRG_#22_Attach5 Script for Verbal Informed Consent for Remote Participants	DCP NSRG_#22_Attach5 Script for Verbal Informed Consent for Remote Participants.docx	01/10/2013

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