2017 Census Test Usability 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⚠️ Notice: This information collection may be referencing outdated material.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 Demographics 2017 Census Test Usability Testing Form and Instruction
Enclosure 1 2017 CT Protocol.docx Instruction
Demographics Demographics Enclosure 4 2017 CT Demographics.docx Form and Instruction
Mobile Experience Mobile Experience Questionnaire Enclosure 5 2017 CT Mobile Experience Questionnaire.docx Form and Instruction
Satisfaction quest Satisfaction questionnaire Enclosure 6 2017 CT Satisfaction questionnaire.docx Form and Instruction
OMB letter_2017 Census Test.docx Memo IC Document
Enclosure 2 Mailing materials placeholder.docx DRAFT Mailing Materials IC Document
Enclosure 3 Placeholder screens for debriefing.pptx DRAFT Screenshots IC Document
OMB letter_2017 Census Test_NEW 071116.docx Revised OMB Memo IC Document

Information Collection (IC) Details

IC Title:	2017 Census Test Usability 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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Demographics	Demographics	Enclosure 4 2017 CT Demographics.docx	Yes	Yes	Paper Only
Form and Instruction	Mobile Experience Questionnaire	Mobile Experience Questionnaire	Enclosure 5 2017 CT Mobile Experience Questionnaire.docx	Yes	Yes	Paper Only
Form and Instruction	Satisfaction questionnaire	Satisfaction questionnaire	Enclosure 6 2017 CT Satisfaction questionnaire.docx	Yes	Yes	Paper Only
Instruction			Enclosure 1 2017 CT Protocol.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: 54	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	54	54
Annual IC Time Burden (Hours)	81	81
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Memo	OMB letter_2017 Census Test.docx	06/15/2016
DRAFT Mailing Materials	Enclosure 2 Mailing materials placeholder.docx	06/15/2016
DRAFT Screenshots	Enclosure 3 Placeholder screens for debriefing.pptx	06/15/2016
Revised OMB Memo	OMB letter_2017 Census Test_NEW 071116.docx	07/20/2016

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