Information Collection

Sub-study #26_Life in A Day Phone Application Study (Usability Study)

IC 206211 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⚠️ Notice: This information collection may be referencing outdated material.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 #26_Life in A Day Phone Application Study (Usability Study)	Form and Instruction
1 Screener_Life Attach1_Life in a Day_Screener.docx	Form and Instruction
2 Day 1 Script Attach2_Day1_Initial interview script_Life.docx	Form and Instruction
3 Day 3 Script Attach3_Day3_Followup interview script_Life.docx	Form and Instruction
Fast-Track_Request_LifeDay_2013 0315.doc Fast-Track_Request_LifeDay_2013 0315	IC Document
Attach4_Consent_Life.docx Attach4_Consent_Life	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Sub-study #26_Life in A Day Phone Application Study (Usability Study)

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	Screener_Life	Attach1_Life in a Day_Screener.docx	No	No	Printable Only
Form and Instruction	2	Day 1 Script	Attach2_Day1_Initial interview script_Life.docx	No	No	Printable Only
Form and Instruction	3	Day 3 Script	Attach3_Day3_Followup interview script_Life.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: 61

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	61	0	0	0	0	0
Annual IC Time Burden (Hours)	46	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
Fast-Track_Request_LifeDay_2013 0315	Fast-Track_Request_LifeDay_2013 0315.doc	03/18/2013
Attach4_Consent_Life	Attach4_Consent_Life.docx	03/18/2013

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