Information Collection

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

IC 209773 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⚠️ Notice: This information collection may be referencing outdated material.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 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

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:

table that charts list of 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 %

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	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

table that charts IC Documents
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.