DPDB Usability Studies

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Document Name Document Type
Form 1 DPDB Usability Studies Form
1 Usability Testing Survey-Website Form Website Form.docx Form
2 Usability Testing Survey-IQRS Form IQRS Form.docx Form
Supporting Statement.docx Supporting Statment IC Document

Information Collection (IC) Details

IC Title:	DPDB Usability Studies	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	1	Usability Testing Survey-Website Form	Website Form.docx		Yes	Yes	Paper Only
Form	2	Usability Testing Survey-IQRS Form	IQRS Form.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	300	0	0	0	0	0
Annual IC Time Burden (Hours)	300	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statment	Supporting Statement.docx	02/20/2014

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