Information Collection

AIAN Enrollment Questions

IC 221552 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⚠️ Notice: This information collection may be referencing outdated material.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 DY-1W-TE1 AIAN Enrollment Questions	Form
DY-1W-TE1 2017 Census Test Experimental Form 1 DY-1W_TE1 (encl 1).pdf	Form
DY-1W TE2 2017 Census Test Experimental Form 2 DY-1W_TE2 (encl 2).pdf	Form
DY-1W TE3 2017 Census Test Experimental Form 3 DY-1W_TE3 (encl 3).pdf	Form
AN Screener AN Screener CI_Screener_Questions_AN 051216 (encl 5).docx	Form and Instruction
AI Screener AI Screener CI_Screener_Questions_AI IMCSA 051216 (encl 6).docx	Form
Protocol 1 Protocol 1 AIAN Tribal Enrollment Q Protocol 1 051316 (encl 7).docx	Form and Instruction
Protocol 2 Protocol 2 AIAN Tribal Enrollment Q Protocol 2 051316 (encl 8).docx	Form and Instruction
Protocol 3 Protocol 3 AIAN Tribal Enrollment Q Protocol 3 051316 (encl 9).docx	Form and Instruction
AIAN TEQ Cog Research OMB Letter 051216.docx Memo	IC Document
Craigslist Ads + Recruitment Flyers + Tribal Publication Ads 051316 (encl 4).docx Recruitment Info	IC Document
Cognitive Interview Consent Form AIAN (encl 10).docx Consent Form	IC Document
AIAN TEQ Cog Research OMB Letter 060816 rlt response clean.docx AIAN TEQ Cog Research REV	IC Document

IC Title:

AIAN Enrollment Questions

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.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DY-1W-TE1	2017 Census Test Experimental Form 1	DY-1W_TE1 (encl 1).pdf	Yes	Yes	Paper Only
Form	DY-1W TE2	2017 Census Test Experimental Form 2	DY-1W_TE2 (encl 2).pdf	Yes	Yes	Paper Only
Form	DY-1W TE3	2017 Census Test Experimental Form 3	DY-1W_TE3 (encl 3).pdf	Yes	Yes	Paper Only
Form and Instruction	AN Screener	AN Screener	CI_Screener_Questions_AN 051216 (encl 5).docx	Yes	Yes	Paper Only
Form	AI Screener	AI Screener	CI_Screener_Questions_AI IMCSA 051216 (encl 6).docx	Yes	Yes	Paper Only
Form and Instruction	Protocol 1	Protocol 1	AIAN Tribal Enrollment Q Protocol 1 051316 (encl 7).docx	Yes	Yes	Paper Only
Form and Instruction	Protocol 2	Protocol 2	AIAN Tribal Enrollment Q Protocol 2 051316 (encl 8).docx	Yes	Yes	Paper Only
Form and Instruction	Protocol 3	Protocol 3	AIAN Tribal Enrollment Q Protocol 3 051316 (encl 9).docx	Yes	Yes	Paper Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 63

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	63	63
Annual IC Time Burden (Hours)	90	90
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Memo	AIAN TEQ Cog Research OMB Letter 051216.docx	05/17/2016
Recruitment Info	Craigslist Ads + Recruitment Flyers + Tribal Publication Ads 051316 (encl 4).docx	05/17/2016
Consent Form	Cognitive Interview Consent Form AIAN (encl 10).docx	05/17/2016
AIAN TEQ Cog Research REV	AIAN TEQ Cog Research OMB Letter 060816 rlt response clean.docx	07/07/2016

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