Generic Clearance for Questionnaire Pretesting Research

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 2017 Economic Cens 2017 Economic Census New Questions	Form and Instruction	New	Available
Form Protocol Protocol	Form and Instruction	New	Available
Form Protocol Protocol	Form and Instruction	New	Available
Form Satisfaction quest Satisfaction questionnaire	Form and Instruction	New	Available
Form Mobile Experience Mobile Experience Questionnaire	Form and Instruction	New	Available
Form Demographics Demographics	Form and Instruction	New	Available
Form AHS Screener AHS Screener	Form and Instruction	New	Available
Form AHS Protocol AHS Protocol	Form and Instruction	New	Available
Form Protocol 3 Protocol 3	Form and Instruction	New	Available
Form Protocol 2 Protocol 2	Form and Instruction	New	Available
Form Protocol 1 Protocol 1	Form and Instruction	New	Available
Form AI Screener AI Screener	Form	New	Available
Form AN Screener AN Screener	Form and Instruction	New	Available
Form DY-1W TE3 2017 Census Test Experimental Form 3	Form	New	Available
Form DY-1W TE2 2017 Census Test Experimental Form 2	Form	New	Available
Form DY-1W-TE1 2017 Census Test Experimental Form 1	Form	New	Available
Form Enc. 5 Recruitment Screener	Form and Instruction	New	Available
Form Enc. 4 Vacant Unit Protocol	Form and Instruction	New	Repair queued
Form Enc. 3 Renter-Occupied Protocol	Form and Instruction	New	Available
Form Enc. 2 Owner-Occupied Protocol	Form and Instruction	New	Available
Form H-100 New York City Housing and Vacancy Survey	Form	New	Available
Form NEW FGP questions NEW FGP questions	Form	New	Available
Form Internet Group 2 V Internet Group 2 Version 1	Form and Instruction	New	Available
Form Paper Group 3 Vers Paper Group 3 Version 2	Form and Instruction	New	Available
Form Paper Group 3 Vers Paper Group 3 Version 1	Form and Instruction	New	Available
Form CAI Group 3 Versio CAI Group 3 Version 2	Form and Instruction	New	Available
Form CAI Group 3 Versio CAI Group 3 Version 1	Form and Instruction	New	Available
Form Internet Group 2 V Internet Group 2 Version 2	Form and Instruction	New	Available
Form CAI Group 2 Versio CAI Group 2 Version 2	Form and Instruction	New	Available
Form CAI Group 2 Versio CAI Group 2 Version 1	Form and Instruction	New	Available
Form Internet Group 1 V Internet Group 1 Version 2	Form and Instruction	New	Available
Form Internet Group 1 V Internet Group 1 Version 1	Form and Instruction	New	Available
Form CAI Group 1 Versio CAI Group 1 Version 2	Form and Instruction	New	Available
Form CAI Group 1 Versio CAI Group 1 Version 1	Form and Instruction	New	Available
Form Debriefing Satisfa Debriefing Satisfaction	Form and Instruction	New	Available
Form Mobile Questions Mobile Questions	Form and Instruction	New	Available
Form Demographics Demographics	Form and Instruction	New	Available
Form Puerto Rico Group Puerto Rico Group Quarters Electronic Transfer Capability Survey	Form and Instruction	New	Available
Form BRDIS Protocol BRDIS Protocol	Form and Instruction	New	Available
Form SBLS Protocol SBLS Protocol	Form and Instruction	New	Available
Form Student Housing Ap Student Housing Apartment Protocol	Form and Instruction	New	Available
Form Student Housing Pr Student Housing Protocol	Form and Instruction	New	Available
Form ASM-RO Debriefing ASM-RO Debriefing	Form and Instruction	New	Available
Form ASM Debriefing ASM Debriefing	Form and Instruction	New	Available
Form 2016 Census Test p 2016 Census Test protocol	Form and Instruction	New	Available
Form AN Moderator Guide AN Moderator Guide	Form	New	Available
Form AI Moderator Guide AI Moderator Guide	Form	New	Available
Form AN Screener AN Screener	Form	New	Available
Form AI Screener AI Screener	Form	New	Available
Form 2016 ASC Business 2016 ASC Business Management Practices Module	Form	New	Available
Form 2016 NRFU 2016 NRFU	Form and Instruction	New	Repair queued
Form Telephone Screener Telephone Screener	Form	New	Available
Form Internet Screener Internet Screener	Form	New	Available
Form Satisfaction Quest Satisfaction Questionnaire	Form	New	Available
Form CFS-1000 Commodity Flow Survey	Form and Instruction	New	Available
Form D1-F DRAFT 2016 Census Form Vietnamese, Russian, and Arabic	Form	New	Available
Form TO09 Study Screene TO09 Study Screener	Form and Instruction	New	Available
Form DF-1 E 2020 Census Bilingual Korean and Chinese Forms	Form and Instruction	New	Available
Form WH-42409 2012 Economic Census	Form	New	Available
Form MP-10002 2015 Management and Organizational Practices Survey (MOPS)	Form	New	Available
Form SA-54150A 2014 Annual Services Report	Form and Instruction	New	Available
Form MC-3100 2012 Econimic Census	Form and Instruction	New	Available
Form BRD-1 BRDIS State	Form	New	Available
Form SA-42A (01-30-2015 2014 Annual Wholesale Trade Report	Form and Instruction	New	Available
Form SA-44C (01-30-2015 2014 Annual Retail Trade Report	Form and Instruction	New	Available
Form ACE-1 (Long) 2012 Annual Capital Expenditures Survey	Form and Instruction	New	Available
Form Dy-1 (CT4B0 2015 National Content Test	Form and Instruction	New	Available
Form DC3309 2014 Census Test Language Flashcard	Form and Instruction	New	Available
nonsubstantive change request $25 for minors.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2013-12-16	Available
OMB Memos under the Generic Clearance -- key elements_FINAL.docx	Supplementary Document	Uploaded 2013-09-30	Available
13genclrAttachmentB.doc	Supplementary Document	Uploaded 2013-06-05	Available
13genclrattachment A.doc	Supplementary Document	Uploaded 2013-06-05	Available
13genclrpartB.doc	Supporting Statement B	Uploaded 2013-06-05	Available
13genclrpartA_nonsubstantive change.doc	Supporting Statement A	Uploaded 2013-12-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
222012	2017 Economic Census New Questions	Form and Instruction	New	2017 Economic Census New Questions
222012	2017 Economic Census New Questions	Instruction	New
221987	NACS for 2017 Economic Census: Round 3	Form and Instruction	New	Protocol
221985	2017 Commodity Flow Survey (CFS) Web questionnaire	Form and Instruction	New	Protocol
221984	2017 Census Test Usability Testing	Form and Instruction	New	Satisfaction questionnaire
221984	2017 Census Test Usability Testing	Form and Instruction	New	Mobile Experience Questionnaire
221984	2017 Census Test Usability Testing	Form and Instruction	New	Demographics
221984	2017 Census Test Usability Testing	Instruction	New
221896	SCOPE Confidentiality Language Testing	Instruction	New
221886	2016 Annual Survey of Manufactures and 2016 Report of Organization	Instruction	New
221659	AHS Revised Modules Cog Testing	Form and Instruction	New	AHS Screener
221659	AHS Revised Modules Cog Testing	Form and Instruction	New	AHS Protocol
221552	AIAN Enrollment Questions	Form and Instruction	New	Protocol 3
221552	AIAN Enrollment Questions	Form and Instruction	New	Protocol 2
221552	AIAN Enrollment Questions	Form and Instruction	New	Protocol 1
221552	AIAN Enrollment Questions	Form	New	AI Screener
221552	AIAN Enrollment Questions	Form and Instruction	New	AN Screener
221552	AIAN Enrollment Questions	Form	New	2017 Census Test Experimental Form 3
221552	AIAN Enrollment Questions	Form	New	2017 Census Test Experimental Form 2
221552	AIAN Enrollment Questions	Form	New	2017 Census Test Experimental Form 1
221546	2016 NYCHVS Spanish Translation Research	Form and Instruction	New	Recruitment Screener
221546	2016 NYCHVS Spanish Translation Research	Form and Instruction	New	Vacant Unit Protocol
221546	2016 NYCHVS Spanish Translation Research	Form and Instruction	New	Renter-Occupied Protocol
221546	2016 NYCHVS Spanish Translation Research	Form and Instruction	New	Owner-Occupied Protocol
221546	2016 NYCHVS Spanish Translation Research	Form	New	New York City Housing and Vacancy Survey
221303	Factoryless Goods Producers for 2017 Economic Census	Form	New	NEW FGP questions
221263	2016 American Community Survey Respondent Burden Testing	Form and Instruction	New	Internet Group 2 Version 1
221263	2016 American Community Survey Respondent Burden Testing	Form and Instruction	New	Paper Group 3 Version 2
221263	2016 American Community Survey Respondent Burden Testing	Form and Instruction	New	Paper Group 3 Version 1
221263	2016 American Community Survey Respondent Burden Testing	Form and Instruction	New	CAI Group 3 Version 2
221263	2016 American Community Survey Respondent Burden Testing	Form and Instruction	New	CAI Group 3 Version 1
221263	2016 American Community Survey Respondent Burden Testing	Form and Instruction	New	Internet Group 2 Version 2
221263	2016 American Community Survey Respondent Burden Testing	Form and Instruction	New	CAI Group 2 Version 2
221263	2016 American Community Survey Respondent Burden Testing	Form and Instruction	New	CAI Group 2 Version 1
221263	2016 American Community Survey Respondent Burden Testing	Form and Instruction	New	Internet Group 1 Version 2
221263	2016 American Community Survey Respondent Burden Testing	Form and Instruction	New	Internet Group 1 Version 1
221263	2016 American Community Survey Respondent Burden Testing	Form and Instruction	New	CAI Group 1 Version 2
221263	2016 American Community Survey Respondent Burden Testing	Form and Instruction	New	CAI Group 1 Version 1
221080	Mobile UI Design Framework for Survey Operations – Phase 1, Study 1	Form and Instruction	New	Debriefing Satisfaction
221080	Mobile UI Design Framework for Survey Operations – Phase 1, Study 1	Form and Instruction	New	Mobile Questions
221080	Mobile UI Design Framework for Survey Operations – Phase 1, Study 1	Form and Instruction	New	Demographics
221080	Mobile UI Design Framework for Survey Operations – Phase 1, Study 1	Instruction	New
220990	American Housing Survey Contact and Incentive Focus Groups	Instruction	New
220989	2017 Puerto Rico Census Focus Group Pretesting	Instruction	New
220601	Usability of the 2017 National Survey of College Graduates (NSCG) online questionnaire	Instruction	New
220596	Puerto Rico Group Quarters Electronic Transfer Capability Survey	Form and Instruction	New	Puerto Rico Group Quarters Electronic Transfer Capability Survey
220324	2016 Business R&D and Innovation Survey (BRDIS)	Form and Instruction	New	BRDIS Protocol
220323	2015 Small Business Lending Survey (SBLS)	Form and Instruction	New	SBLS Protocol
220049	2016 Census Student Housing Definition Group Quarters	Form and Instruction	New	Student Housing Apartment Protocol
220049	2016 Census Student Housing Definition Group Quarters	Form and Instruction	New	Student Housing Protocol
219595	2015 ASM-RO Worksheet Prototype Debriefings	Form and Instruction	New	ASM-RO Debriefing
219563	Respondent debriefings - Web instrument - 2015 Annual Survey of Manufactures (ASM)	Form and Instruction	New	ASM Debriefing
219325	MOPS Usability Testing	Instruction	New
219313	NSCG Contact Materials		New
219177	2016 Census Test online questionnaire non-English testing	Form and Instruction	New	2016 Census Test protocol
219050	AIAN Tribal Enrollment	Form	New	AN Moderator Guide
219050	AIAN Tribal Enrollment	Form	New	AI Moderator Guide
219050	AIAN Tribal Enrollment	Form	New	AN Screener
219050	AIAN Tribal Enrollment	Form	New	AI Screener
218830	2016 ASE	Form	New	2016 ASC Business Management Practices Module
218733	2016 COMPASS NRFU	Form and Instruction	New	2016 NRFU
218731	FY16 Generic Screeners	Form	New	Telephone Screener
218731	FY16 Generic Screeners	Form	New	Internet Screener
218707	Census User Identification Codes Usability Testing	Form	New	Satisfaction Questionnaire
218707	Census User Identification Codes Usability Testing	Instruction	New
218201	Census Business Builder Online Tool	Instruction	New
218095	2017 Commodity Flow Survey Pretest	Form and Instruction	New	Commodity Flow Survey
218011	2020 Census Billinugal Vietnamese, Russian, and Arabic	Form	New	2016 Census Form Vietnamese, Russian, and Arabic
218011	2020 Census Billinugal Vietnamese, Russian, and Arabic	Instruction	New
217853	2020 Chinese Korean Bilingual Forms	Form and Instruction	New	TO09 Study Screener
217853	2020 Chinese Korean Bilingual Forms	Form and Instruction	New	2020 Census Bilingual Korean and Chinese Forms
217853	2020 Chinese Korean Bilingual Forms	Other-Memo	New
217795	NCVS SVS	Other-Pretesting Questionnaire	New
217438	2016 Census Letter Cognitive Testing	Other-Protocol for 2016 Census Test Letters and Postcards	New
217372	State Government Research and Development (SGRD)	Other-SGRD Usability Testing Draft Protocol	New
217301	Factoryless Goods Producers (FGP)	Other-Establishment FGP Concept Early Stage Scoping Draft Protoc	New
217098	Annual Survey of Entrepreneurs	Other-Online Survey Instrument	New
217096	North American Products Classification System (NAPCS)	Form	New	2012 Economic Census
217096	North American Products Classification System (NAPCS)	Other-Enclosure 1 - Research Questions	New
217095	Federal Deposit Insurance Corporation's Survey	Other-Enclosure 1 - Screener	New
217038	Group Quarters Electronic Transfer Capability Survey (GQETCS)	Other-GQETCS Online Instrument	New
216878	2015 Management and Organizational Practices Survey (MOPS)	Form	New	2015 Management and Organizational Practices Survey (MOPS)
216878	2015 Management and Organizational Practices Survey (MOPS)	Other-Research Questions	New
216847	2015 National Content Test Usability and Cognitive Testing	Other-Interview Format	New
216643	Company Organization Survey - Enterprise Statistics Program (ESP)	Other-Draft Protocol	New
216641	Online ACS Mobile Device	Other-Demographic Information	New
216596	Questionnaire Pretesting Research - ECON Hub Business Unit Harmonization Team	Form and Instruction	New	2014 Annual Services Report
216596	Questionnaire Pretesting Research - ECON Hub Business Unit Harmonization Team	Form and Instruction	New	2012 Econimic Census
216596	Questionnaire Pretesting Research - ECON Hub Business Unit Harmonization Team	Form	New	BRDIS State
216596	Questionnaire Pretesting Research - ECON Hub Business Unit Harmonization Team	Form and Instruction	New	2014 Annual Wholesale Trade Report
216596	Questionnaire Pretesting Research - ECON Hub Business Unit Harmonization Team	Form and Instruction	New	2014 Annual Retail Trade Report
216596	Questionnaire Pretesting Research - ECON Hub Business Unit Harmonization Team	Form and Instruction	New	2012 Annual Capital Expenditures Survey
216596	Questionnaire Pretesting Research - ECON Hub Business Unit Harmonization Team	Instruction	New
216576	Decennial Language Research	Form and Instruction	New	2015 National Content Test
216576	Decennial Language Research	Form and Instruction	New	2014 Census Test Language Flashcard
216576	Decennial Language Research	Other-Moderator's Guide	New
211844	Various Economic Area Pretesting Activities	Other-2012 SBO Debriefing Interviews Enclosure	New
210879	Various Demographic Area Pretesting Activities	Other-Opt-In GovDelivery Panel Testing Enclosure	New
210394	Various Economic Area Pretesting Activities	Other-Survey of Business Owners Enclosure 1	New
208987	Various Government Pretesting Activities	Other-2013 Annual Survey of Public Pensions Pretesting Enclosure	Unchanged

ICR Details

OMB Control No: 0607-0725	ICR Reference No: 201312-0607-004
Status: Historical Active	Previous ICR Reference No: 201306-0607-001
Agency/Subagency: DOC/CENSUS	Agency Tracking No:
Title: Generic Clearance for Questionnaire Pretesting Research
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/24/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/08/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2016	08/31/2016	08/31/2016
Responses	16,500	0	16,500
Time Burden (Hours)	16,500	0	16,500
Cost Burden (Dollars)	0	0	0

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Abstract: The research will be used by the Census Bureau and the survey sponsors to improve questionnaires and procedures, reduce respondent burden, and ultimately increase the quality of data collected in Census Bureau censuses and surveys.

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Authorizing Statute(s): US Code: 13 USC 131, 141, 161, 181, 182, 193,
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 23743	04/22/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 41029	07/09/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 51

table that charts list of burden

IC Title	Form No.	Form Name
2015 ASM-RO Worksheet Prototype Debriefings	ASM-RO Debriefing	ASM-RO Debriefing
2015 Management and Organizational Practices Survey (MOPS)	MP-10002	2015 Management and Organizational Practices Survey (MOPS)
2015 National Content Test Usability and Cognitive Testing
2015 Small Business Lending Survey (SBLS)	SBLS Protocol	SBLS Protocol
2016 ASE	2016 ASC Business Management Practices Module	2016 ASC Business Management Practices Module
2016 American Community Survey Respondent Burden Testing	Internet Group 2 Version 2, Internet Group 1 Version 1, CAI Group 1 Version 1, CAI Group 2 Version 1, CAI Group 2 Version 2, CAI Group 3 Version 2, Paper Group 3 Version 1, Internet Group 1 Version 2, CAI Group 3 Version 1, Paper Group 3 Version 2, CAI Group 1 Version 2, Internet Group 2 Version 1	CAI Group 1 Version 1 ,   CAI Group 1 Version 2 ,   Internet Group 1 Version 1 ,   Internet Group 1 Version 2 ,   CAI Group 2 Version 1 ,   CAI Group 2 Version 2 ,   Internet Group 2 Version 2 ,   CAI Group 3 Version 1 ,   CAI Group 3 Version 2 ,   Paper Group 3 Version 1 ,   Paper Group 3 Version 2 ,   Internet Group 2 Version 1
2016 Annual Survey of Manufactures and 2016 Report of Organization
2016 Business R&D and Innovation Survey (BRDIS)	BRDIS Protocol	BRDIS Protocol
2016 COMPASS NRFU	2016 NRFU	2016 NRFU
2016 Census Letter Cognitive Testing
2016 Census Student Housing Definition Group Quarters	Student Housing Protocol, Student Housing Apartment Protocol	Student Housing Protocol ,   Student Housing Apartment Protocol
2016 Census Test online questionnaire non-English testing	2016 Census Test protocol	2016 Census Test protocol
2016 NYCHVS Spanish Translation Research	H-100, Enc. 3, Enc. 2, Enc. 4, Enc. 5	New York City Housing and Vacancy Survey ,   Owner-Occupied Protocol ,   Renter-Occupied Protocol ,   Vacant Unit Protocol ,   Recruitment Screener
2017 Census Test Usability Testing	Demographics, Mobile Experience Questionnaire, Satisfaction questionnaire	Demographics ,   Mobile Experience Questionnaire ,   Satisfaction questionnaire
2017 Commodity Flow Survey (CFS) Web questionnaire	Protocol	Protocol
2017 Commodity Flow Survey Pretest	CFS-1000	Commodity Flow Survey
2017 Economic Census New Questions	2017 Economic Census New Questions	2017 Economic Census New Questions
2017 Puerto Rico Census Focus Group Pretesting
2020 Census Billinugal Vietnamese, Russian, and Arabic	D1-F DRAFT	2016 Census Form Vietnamese, Russian, and Arabic
2020 Chinese Korean Bilingual Forms	DF-1 E, TO09 Study Screener	2020 Census Bilingual Korean and Chinese Forms ,   TO09 Study Screener
AHS Revised Modules Cog Testing	AHS Protocol , AHS Screener	AHS Protocol ,   AHS Screener
AIAN Enrollment Questions	AI Screener, Protocol 1, Protocol 2, Protocol 3, DY-1W-TE1, DY-1W TE2, DY-1W TE3, AN Screener	2017 Census Test Experimental Form 1 ,   2017 Census Test Experimental Form 2 ,   2017 Census Test Experimental Form 3 ,   AN Screener ,   AI Screener ,   Protocol 1 ,   Protocol 2 ,   Protocol 3
AIAN Tribal Enrollment	AI Screener, AN Screener, AI Moderator Guide, AN Moderator Guide	AI Screener ,   AN Screener ,   AI Moderator Guide ,   AN Moderator Guide
American Housing Survey Contact and Incentive Focus Groups
Annual Survey of Entrepreneurs
Census Business Builder Online Tool
Census User Identification Codes Usability Testing	Satisfaction Questionnaire	Satisfaction Questionnaire
Company Organization Survey - Enterprise Statistics Program (ESP)
Decennial Language Research	Dy-1 (CT4B0, DC3309	2014 Census Test Language Flashcard ,   2015 National Content Test
FY16 Generic Screeners	Internet Screener, Telephone Screener	Internet Screener ,   Telephone Screener
Factoryless Goods Producers (FGP)
Factoryless Goods Producers for 2017 Economic Census	NEW FGP questions	NEW FGP questions
Federal Deposit Insurance Corporation's Survey
Group Quarters Electronic Transfer Capability Survey (GQETCS)
MOPS Usability Testing
Mobile UI Design Framework for Survey Operations – Phase 1, Study 1	Demographics, Mobile Questions, Debriefing Satisfaction	Demographics ,   Mobile Questions ,   Debriefing Satisfaction
NACS for 2017 Economic Census: Round 3	Protocol	Protocol
NCVS SVS
NSCG Contact Materials
North American Products Classification System (NAPCS)	WH-42409	2012 Economic Census
Online ACS Mobile Device
Puerto Rico Group Quarters Electronic Transfer Capability Survey	Puerto Rico Group Quarters Electronic Transfer Cap	Puerto Rico Group Quarters Electronic Transfer Capability Survey
Questionnaire Pretesting Research - ECON Hub Business Unit Harmonization Team	SA-42A (01-30-2015), BRD-1, ACE-1 (Long), SA-44C (01-30-2015), MC-3100, SA-54150A	2012 Annual Capital Expenditures Survey ,   2014 Annual Retail Trade Report ,   2014 Annual Wholesale Trade Report ,   BRDIS State ,   2012 Econimic Census ,   2014 Annual Services Report
Respondent debriefings - Web instrument - 2015 Annual Survey of Manufactures (ASM)	ASM Debriefing	ASM Debriefing
SCOPE Confidentiality Language Testing
State Government Research and Development (SGRD)
Usability of the 2017 National Survey of College Graduates (NSCG) online questionnaire
Various Demographic Area Pretesting Activities
Various Economic Area Pretesting Activities
Various Economic Area Pretesting Activities
Various Government Pretesting Activities

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	16,500	16,500	0	0	0	0
Annual Time Burden (Hours)	16,500	16,500	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/08/2014

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