Sub-study #35_Cognitive Interviewing for Item Bank in Computer Adaptive Testing Instrument

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 2 Sub-study #35_Cognitive Interviewing for Item Bank in Computer Adaptive Testing Instrument Form and Instruction
2 Consent Form Attachment 4_Consent_Cog Testing_OMB.pdf Form and Instruction
1 Moderator's Guide Attachment 3_CogIntervModerator Guide.docx Form and Instruction
Fast Track Cog Test Item Bank Request.doc Fast Track Cog Test Item Bank Request IC Document
Attachment 1_Recruitment Flier.docx Attachment 1_Recruitment Flier IC Document
Attachment 2_Questions to be Tested.docx Attachment 2_Questions to be Tested IC Document

Information Collection (IC) Details

IC Title:	Sub-study #35_Cognitive Interviewing for Item Bank in Computer Adaptive Testing Instrument	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2	Consent Form	Attachment 4_Consent_Cog Testing_OMB.pdf		Yes	No	Printable Only
Form and Instruction	1	Moderator's Guide	Attachment 3_CogIntervModerator Guide.docx		Yes	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 140	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	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	140	0	0	0	0	0
Annual IC Time Burden (Hours)	76	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Fast Track Cog Test Item Bank Request	Fast Track Cog Test Item Bank Request.doc	12/12/2013
Attachment 1_Recruitment Flier	Attachment 1_Recruitment Flier.docx	12/12/2013
Attachment 2_Questions to be Tested	Attachment 2_Questions to be Tested.docx	12/12/2013

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