Information Collection

Pretest Survey

IC 202022 under ICR 201309-0955-001 · OMB 0955-0001.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990- ONC-ConsumerSurvey.docx	Other-survey
ONCConsumerPrivacySurveyFinalSpanish.docx	Other-Consumer Privacy Survey Spanis
ONCConsumerPrivacySurveyFinal05-02-2012.docx	Other-Consumer Privacy Survey
0990-ONCcunsumerBriefing Slides Cognitive Interviews_022912.pptx	Other-ConsumerBriefing Slides Cognit
0990-ONCConsumerPrivacySurvey Questionnaire Final6 19.docx	Other-ONCConsumerPrivacySurvey Quest
ONCConsumerPrivacySurveyIntroScriptSpanish.docx ONCConsumerPrivacySurveyIntroScriptSpanish	IC Document
ONCConsumerPrivacySurveyIntroScript.docx ONCConsumerPrivacySurveyIntroScript	IC Document

IC Title:

Pretest Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-survey	0990- ONC-ConsumerSurvey.docx	Yes	Yes	Printable Only
Other-Consumer Privacy Survey Spanish	ONCConsumerPrivacySurveyFinalSpanish.docx	Yes	Yes	Printable Only
Other-Consumer Privacy Survey	ONCConsumerPrivacySurveyFinal05-02-2012.docx	Yes	Yes	Printable Only
Other-ConsumerBriefing Slides Cognitive Interviews_022912	0990-ONCcunsumerBriefing Slides Cognitive Interviews_022912.pptx	Yes	No	Printable Only
Other-ONCConsumerPrivacySurvey Questionnaire Final6 19	0990-ONCConsumerPrivacySurvey Questionnaire Final6 19.docx	Yes	No	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 33

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	Previously Approved
Annual Number of Responses for this IC	33	33
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
ONCConsumerPrivacySurveyIntroScriptSpanish	ONCConsumerPrivacySurveyIntroScriptSpanish.docx	05/15/2012
ONCConsumerPrivacySurveyIntroScript	ONCConsumerPrivacySurveyIntroScript.docx	05/15/2012

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