AHS Revised Modules Cog Testing

Generic Clearance for Questionnaire Pretesting Research

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

IC Title:	AHS Revised Modules Cog Testing	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.