Information Collection

Cognitive interviews for the CV checklist

IC 206681 under ICR 201304-0935-003 · OMB 0935-0211.

Documents and Forms

Document Name Document Type
Form Form #9 Cognitive interviews for the CV checklist Form and Instruction
Form #9 Cognitive Interview Guide for CV Checklist Attachment K - Cognitive Interview Guide for CV Checklist.docx Form and Instruction
Attachment L - Draft CV Checklist.docx Attachment L - Draft CV Checklist IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Cognitive interviews for the CV checklist	Agency IC Tracking Number:

Is this a Common Form? No		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	Form #9	Cognitive Interview Guide for CV Checklist	Attachment K - Cognitive Interview Guide for CV Checklist.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	18	18
Annual IC Time Burden (Hours)	18	18
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment L - Draft CV Checklist	Attachment L - Draft CV Checklist.docx	04/19/2013

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