Information Collection

Conduct Cognitive Testing of Test Survey Questions

IC 200298 under ICR 201208-0955-005 · OMB 0955-0005.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0955-0005 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-0376_Attachment 1 Consumer Privacy Security Cognitive Recruitment Screener.docx	Other-testing
0990-0376_Attachment 2 Consumer Privacy Security Cognitive Interview Protocol.docx	Other-testing
0990-0376_Attachement 3 Consumer Privacy Security Survey Questions.docx	Other-testing
0990-0376_Attachment 4 Consumer Privacy Security Spanish Cognitive Recruitment Screener.doc	Other-test
0990-0376_Attachment 6 Consumer Privacy Security Spanish Survey Questions Main.docx	Other-test
0990-0376_Attachment 5 Consumer Privacy Security Spanish Cognitive Interview Protocol.docx 0990-0376_Attachment 5 Consumer Privacy Security Spanish Cognitive Interview Protocol	IC Document
0990-0376_Mini Supporting Statement Cognitive Testing Consumer Privacy Security.docx 0990-0376_Mini Supporting Statement Cognitive Testing Consumer Privacy Security	IC Document

IC Title:

Conduct Cognitive Testing of Test Survey Questions

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-testing	0990-0376_Attachment 1 Consumer Privacy Security Cognitive Recruitment Screener.docx	Yes	Yes	Fillable Printable
Other-testing	0990-0376_Attachment 2 Consumer Privacy Security Cognitive Interview Protocol.docx	Yes	Yes	Printable Only
Other-testing	0990-0376_Attachement 3 Consumer Privacy Security Survey Questions.docx	Yes	Yes	Printable Only
Other-test	0990-0376_Attachment 4 Consumer Privacy Security Spanish Cognitive Recruitment Screener.doc	Yes	Yes	Printable Only
Other-test	0990-0376_Attachment 6 Consumer Privacy Security Spanish Survey Questions Main.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	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	25	0	0	0	0	0
Annual IC Time Burden (Hours)	38	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
0990-0376_Attachment 5 Consumer Privacy Security Spanish Cognitive Interview Protocol	0990-0376_Attachment 5 Consumer Privacy Security Spanish Cognitive Interview Protocol.docx	11/30/2011
0990-0376_Mini Supporting Statement Cognitive Testing Consumer Privacy Security	0990-0376_Mini Supporting Statement Cognitive Testing Consumer Privacy Security.docx	11/30/2011

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