Information Collection

AHS Revised Modules Cog Testing

IC 221659 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⚠️ Notice: This information collection may be referencing outdated material.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 AHS Protocol AHS Revised Modules Cog Testing	Form and Instruction
AHS Protocol AHS Protocol AHS FINAL Protocol_Round 1_05232016.docx	Form and Instruction
AHS Screener AHS Screener Recruitment Screener 160520.docx	Form and Instruction
OMB Memo_FINAL.docx Memo	IC Document
OMB Memo_FINAL (2)_SSP.docx OMB Memo FINAL Revised	IC Document

IC Title:

AHS Revised Modules Cog Testing

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	AHS Protocol	AHS Protocol	AHS FINAL Protocol_Round 1_05232016.docx		Yes	Yes	Paper Only
Form and Instruction	AHS Screener	AHS Screener	Recruitment Screener 160520.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: 35

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	35	35
Annual IC Time Burden (Hours)	53	53
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Memo	OMB Memo_FINAL.docx	05/23/2016
OMB Memo FINAL Revised	OMB Memo_FINAL (2)_SSP.docx	06/17/2016

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