Information Collection

Open Call Usability Testing (NCI)

IC 217694 under ICR 201304-0925-003 · OMB 0925-0046.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0046 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Attachment 1 Screener Lay Consumers English Open Call Usability Testing (NCI)	Form and Instruction
Form 2 Attachment 3 Screener Lay Consumers Spanish Open Call Usability Testing (NCI)	Form and Instruction
Form 3 Attadchment 2 Screener Healthcare Professionals English Open Call Usability Testing (NCI)	Form and Instruction
Form 4 Attachment 4 Screener Healthcare Professionals Spanish Open Call Usability Testing (NCI)	Form and Instruction
Form 5 Attachment 7 Informed Consent Form English Open Call Usability Testing (NCI)	Form and Instruction
Form 6 Attachment 8 Informed Consent Form Spanish Open Call Usability Testing (NCI)	Form and Instruction
Form 7 Attachment 5 Usability Testing Open Call Usability Testing (NCI)	Form and Instruction
Form 8 Attachment 6 Usability Testing Spanish Open Call Usability Testing (NCI)	Form and Instruction
1 Attachment 1 Screener Lay Consumers English Attachment 1 Screener Lay Consumers_English.doc	Form and Instruction
2 Attachment 3 Screener Lay Consumers Spanish Attachment 3 Screener Lay Consumers_Spanish.doc	Form and Instruction
3 Attadchment 2 Screener Healthcare Professionals English Attachment 2 Screener Healthcare Professionals_English.doc	Form and Instruction
4 Attachment 4 Screener Healthcare Professionals Spanish Attachment 4 Screener Healthcare Professionals_Spanish.doc	Form and Instruction
5 Attachment 7 Informed Consent Form English Attachment 7 Informed Consent Form (English).doc	Form and Instruction
6 Attachment 8 Informed Consent Form Spanish Attachment 8 Informed Consent Form (Spanish).doc	Form and Instruction
7 Attachment 5 Usability Testing Attachment 5 Moderator Guide_English.doc	Form and Instruction
8 Attachment 6 Usability Testing Spanish Attachment 6 Moderator Guide_Spanish.doc	Form and Instruction
Attachment 9 IRB Approval.pdf Attachment 9 IRB Approval	IC Document
Open Call OMB SSA submission_FINAL 8.13.2015.docx Open Call OMB SSA submission	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Open Call Usability Testing (NCI)

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Yes	Yes	Fillable Fileable
Form and Instruction	2	Yes	Yes	Fillable Fileable
Form and Instruction	3	Yes	Yes	Fillable Fileable
Form and Instruction	4	Yes	Yes	Fillable Fileable
Form and Instruction	5	Yes	Yes	Fillable Fileable
Form and Instruction	6	Yes	Yes	Fillable Fileable
Form and Instruction	7	Yes	Yes	Fillable Fileable
Form and Instruction	8	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 492

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 Agency Discretion
Annual Number of Responses for this IC	492	492
Annual IC Time Burden (Hours)	172	172
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 9 IRB Approval		08/13/2015
Open Call OMB SSA submission		08/17/2015

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].