Information Collection

Sub-study #23 NCCOR Website Usability Testing

IC 205913 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⚠️ Notice: This information collection may be referencing outdated material.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 Sub-study #23 NCCOR Website Usability Testing	Form and Instruction
1 Facilitator's Guide - Catalogue NCCOR_#23_Attach_4 Facilitator's guide Catalogue Surv_2-19-2013_REV.docx	Form and Instruction
2 Facilitator's Guide - Measures NCCOR_#23_Attach_5 Facilitator's guide Measures_2-19-2013.docx	Form and Instruction
3 Recruit Phone Call NCCOR_#23_Attach_6 Fup Recruit Phone call_2-19-2013.docx	Form and Instruction
NCCOR_#23_Attach_1 Recruit Email_2-19-2013.docx NCCOR_#23_Attach_1 Recruit Email_2-19-2013	IC Document
NCCOR_#23_Attach_2 Written Consent_2-19-2013.doc NCCOR_#23_Attach_2 Written Consent_2-19-2013	IC Document
NCCOR_#23_Attach_3 Verbal Consent_2-19-2013.docx NCCOR_#23_Attach_3 Verbal Consent_2-19-2013	IC Document
NCCOR Fast-Track_Request #23.doc NCCOR Fast-Track_Request #23	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Sub-study #23 NCCOR 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	Facilitator's Guide - Catalogue	NCCOR_#23_Attach_4 Facilitator's guide Catalogue Surv_2-19-2013_REV.docx	No	No	Printable Only
Form and Instruction	2	Facilitator's Guide - Measures	NCCOR_#23_Attach_5 Facilitator's guide Measures_2-19-2013.docx	No	No	Printable Only
Form and Instruction	3	Recruit Phone Call	NCCOR_#23_Attach_6 Fup Recruit Phone call_2-19-2013.docx	No	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: 91

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	91	0	0	0	0	0
Annual IC Time Burden (Hours)	54	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
NCCOR_#23_Attach_1 Recruit Email_2-19-2013	NCCOR_#23_Attach_1 Recruit Email_2-19-2013.docx	02/19/2013
NCCOR_#23_Attach_2 Written Consent_2-19-2013	NCCOR_#23_Attach_2 Written Consent_2-19-2013.doc	02/19/2013
NCCOR_#23_Attach_3 Verbal Consent_2-19-2013	NCCOR_#23_Attach_3 Verbal Consent_2-19-2013.docx	02/19/2013
NCCOR Fast-Track_Request #23	NCCOR Fast-Track_Request #23.doc	02/19/2013

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