Information Collection

Sub-study #33_User Simulation Study for NIH-SSA Collaboration to Improve Disability Determination (Revised)

IC 209220 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⚠️ Notice: This information collection may be referencing outdated material.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 #33_User Simulation Study for NIH-SSA Collaboration to Improve Disability Determination (Revised)	Form and Instruction
1 Item Bank Behavioral Health Questions Attach A_REVISED_All Behavioral Health CAT Items_11-5-2013.doc	Form and Instruction
2 Item Bank Physical Function Questions Attach B_REVISED_All PF CAT Items_11-5-2013.doc	Form and Instruction
3 Initial Screenshot of CAT Attach C_ CAT Instrument Screen Shot.doc	Form and Instruction
4 Debriefing Interview for Feds Attach E_REVISED Debriefing Interview Questions for Feds.doc	Form and Instruction
#33_REVISED Fast-Track_SSA User Simulation.doc #33_REVISED Fast-Track_SSA User Simulation	IC Document
Attach D_IRB Exempt.pdf Attach D_IRB Exempt	IC Document

IC Title:

Sub-study #33_User Simulation Study for NIH-SSA Collaboration to Improve Disability Determination (Revised)

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	Item Bank Behavioral Health Questions	Attach A_REVISED_All Behavioral Health CAT Items_11-5-2013.doc	Yes	Yes	Fillable Fileable
Form and Instruction	2	Item Bank Physical Function Questions	Attach B_REVISED_All PF CAT Items_11-5-2013.doc	Yes	Yes	Fillable Fileable
Form and Instruction	3	Initial Screenshot of CAT	Attach C_ CAT Instrument Screen Shot.doc	Yes	Yes	Fillable Fileable
Form and Instruction	4	Debriefing Interview for Feds	Attach E_REVISED Debriefing Interview Questions for Feds.doc	No	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 125

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

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	125	0	0	0	0	0
Annual IC Time Burden (Hours)	63	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
#33_REVISED Fast-Track_SSA User Simulation	#33_REVISED Fast-Track_SSA User Simulation.doc	11/05/2013
Attach D_IRB Exempt	Attach D_IRB Exempt.pdf	11/05/2013

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