Information Collection

2016 American Community Survey Respondent Burden Testing

IC 221263 under ICR 201312-0607-004 · OMB 0607-0725.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0725 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Internet Group 2 V 2016 American Community Survey Respondent Burden Testing	Form and Instruction
CAI Group 1 Versio CAI Group 1 Version 1 Attachment B 2016 ACS Respondent Burden Testing_FINAL Protocol_ CAI Group 1 Version 1_to CB 042516.docx	Form and Instruction
CAI Group 1 Versio CAI Group 1 Version 2 Attachment C 2016 ACS Respondent Burden Testing_FINAL Protocol_CAI Group 1 Version 2_to CB 042516.docx	Form and Instruction
Internet Group 1 V Internet Group 1 Version 1 Attachment D 2016 ACS Respondent Burden Testing_FINAL Protocol_Internet Group 1 Version 1_to CB 042516.docx	Form and Instruction
Internet Group 1 V Internet Group 1 Version 2 Attachment E 2016 ACS Respondent Burden Testing_FINALT Protocol_Internet Group 1 Version 2_to CB 042516.docx	Form and Instruction
CAI Group 2 Versio CAI Group 2 Version 1 Attachment F 2016 ACS Respondent Burden Testing_FINAL Protocol_CAI Group 2 Version 1_to CB_042516.docx	Form and Instruction
CAI Group 2 Versio CAI Group 2 Version 2 Attachment G 2016 ACS Respondent Burden Testing_FINAL Protocol_CAI Group 2 Version 2_ to CB_042516.docx	Form and Instruction
Internet Group 2 V Internet Group 2 Version 2 Attachment I 2016 ACS Respondent Burden Testing_FINAL Protocol_Internet Group 2 Version 2_to CB_042516.docx	Form and Instruction
CAI Group 3 Versio CAI Group 3 Version 1 Attachment J 2016 ACS Respondent Burden Testing_FINAL Protocol_CAI Group 3 Version 1_to CB_042516.docx	Form and Instruction
CAI Group 3 Versio CAI Group 3 Version 2 Attachment K 2016 ACS Respondent Burden Testing_FINAL Protocol_DRAFT CAI Group 3 Version 2_to CB_042516.docx	Form and Instruction
Paper Group 3 Vers Paper Group 3 Version 1 Attachment L 2016 ACS Respondent Burden Testing_FINAL Protocol_Paper Group 3 Version 1_to CB_042516.docx	Form and Instruction
Paper Group 3 Vers Paper Group 3 Version 2 Attachment M 2016 ACS Respondent Burden Testing_FINAL Protocol_Paper Group 3 Version 2_to CB_042516.docx	Form and Instruction
Internet Group 2 V Internet Group 2 Version 1 Attachment H 2016 ACS Respondent Burden Testing_FINAL Protocol_Internet Group 2 Version 1_to CB_042516.docx	Form and Instruction
Attachment A ACS Respondent Burden Testing_FINAL Recruitment Plan_to CB 042516.docx Recruitment Screener	IC Document
Attachment N ACS Cog Test CAI Roster_revised_042516.doc Roster	IC Document
Attachment O CAI_V1_Group 1 and 2.docx CAI_V1	IC Document
Attachment P CAI_V2_Group 1 and 2.docx CAI_V2	IC Document
Attachment Q CAI_V1_Group 3.doc CAI_V1_Group 3	IC Document
Attachment R CAI_V2_Group 3.doc CAI_V2 Group 3	IC Document
Attachment S Group 1 Version 1 Internet Screens.pdf Internet Version 1 Group 1	IC Document
Attachment T Group 1 Version 2 Internet Screens.pdf Interent Group 1 Version 2	IC Document
Attachment U Group 2 Version 1 Internet Screens.pdf Internet Group 2 Version 1	IC Document
Attachment V Group 2 Version 2 Internet Screens.pdf Internet Group 2 Version 2	IC Document
Attachment W Paper Questionnaire Group 3 Version 1 ACS-1(X)G3V1_final.pdf Paper Group 3 Version 1	IC Document
Attachment X Paper Questionnaire Group 3 Version 2 ACS-1(X)G3V2_final.pdf Paper Group 3 Verion 2	IC Document
Attachment Y 2016 ACS Respondent Burden Testing_FINAL Consent Form 042516.doc Consent Form	IC Document
OMB Memo for Westat Cognitive Testing 5-20-2016.docx Memo	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

2016 American Community Survey Respondent Burden Testing

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 13 CFR 141, 193 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Internet Group 2 Version 1	Internet Group 2 Version 1	Attachment H 2016 ACS Respondent Burden Testing_FINAL Protocol_Internet Group 2 Version 1_to CB_042516.docx	Yes	Yes	Paper Only
Form and Instruction	CAI Group 1 Version 1	CAI Group 1 Version 1	Attachment B 2016 ACS Respondent Burden Testing_FINAL Protocol_ CAI Group 1 Version 1_to CB 042516.docx	Yes	Yes	Paper Only
Form and Instruction	CAI Group 1 Version 2	CAI Group 1 Version 2	Attachment C 2016 ACS Respondent Burden Testing_FINAL Protocol_CAI Group 1 Version 2_to CB 042516.docx	Yes	Yes	Paper Only
Form and Instruction	Internet Group 1 Version 1	Internet Group 1 Version 1	Attachment D 2016 ACS Respondent Burden Testing_FINAL Protocol_Internet Group 1 Version 1_to CB 042516.docx	Yes	Yes	Paper Only
Form and Instruction	Internet Group 1 Version 2	Internet Group 1 Version 2	Attachment E 2016 ACS Respondent Burden Testing_FINALT Protocol_Internet Group 1 Version 2_to CB 042516.docx	Yes	Yes	Paper Only
Form and Instruction	CAI Group 2 Version 1	CAI Group 2 Version 1	Attachment F 2016 ACS Respondent Burden Testing_FINAL Protocol_CAI Group 2 Version 1_to CB_042516.docx	Yes	Yes	Paper Only
Form and Instruction	CAI Group 2 Version 2	CAI Group 2 Version 2	Attachment G 2016 ACS Respondent Burden Testing_FINAL Protocol_CAI Group 2 Version 2_ to CB_042516.docx	Yes	Yes	Paper Only
Form and Instruction	Internet Group 2 Version 2	Internet Group 2 Version 2	Attachment I 2016 ACS Respondent Burden Testing_FINAL Protocol_Internet Group 2 Version 2_to CB_042516.docx	Yes	Yes	Paper Only
Form and Instruction	CAI Group 3 Version 1	CAI Group 3 Version 1	Attachment J 2016 ACS Respondent Burden Testing_FINAL Protocol_CAI Group 3 Version 1_to CB_042516.docx	Yes	Yes	Paper Only
Form and Instruction	CAI Group 3 Version 2	CAI Group 3 Version 2	Attachment K 2016 ACS Respondent Burden Testing_FINAL Protocol_DRAFT CAI Group 3 Version 2_to CB_042516.docx	Yes	Yes	Paper Only
Form and Instruction	Paper Group 3 Version 1	Paper Group 3 Version 1	Attachment L 2016 ACS Respondent Burden Testing_FINAL Protocol_Paper Group 3 Version 1_to CB_042516.docx	Yes	Yes	Paper Only
Form and Instruction	Paper Group 3 Version 2	Paper Group 3 Version 2	Attachment M 2016 ACS Respondent Burden Testing_FINAL Protocol_Paper Group 3 Version 2_to CB_042516.docx	Yes	Yes	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 72

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	72	72
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Recruitment Screener	Attachment A ACS Respondent Burden Testing_FINAL Recruitment Plan_to CB 042516.docx	04/26/2016
Roster	Attachment N ACS Cog Test CAI Roster_revised_042516.doc	04/26/2016
CAI_V1	Attachment O CAI_V1_Group 1 and 2.docx	04/26/2016
CAI_V2	Attachment P CAI_V2_Group 1 and 2.docx	04/26/2016
CAI_V1_Group 3	Attachment Q CAI_V1_Group 3.doc	04/26/2016
CAI_V2 Group 3	Attachment R CAI_V2_Group 3.doc	04/26/2016
Internet Version 1 Group 1	Attachment S Group 1 Version 1 Internet Screens.pdf	04/26/2016
Interent Group 1 Version 2	Attachment T Group 1 Version 2 Internet Screens.pdf	04/26/2016
Internet Group 2 Version 1	Attachment U Group 2 Version 1 Internet Screens.pdf	04/26/2016
Internet Group 2 Version 2	Attachment V Group 2 Version 2 Internet Screens.pdf	04/26/2016
Paper Group 3 Version 1	Attachment W Paper Questionnaire Group 3 Version 1 ACS-1(X)G3V1_final.pdf	04/26/2016
Paper Group 3 Verion 2	Attachment X Paper Questionnaire Group 3 Version 2 ACS-1(X)G3V2_final.pdf	04/26/2016
Consent Form	Attachment Y 2016 ACS Respondent Burden Testing_FINAL Consent Form 042516.doc	04/26/2016
Memo	OMB Memo for Westat Cognitive Testing 5-20-2016.docx	05/20/2016

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