Information Collection

2017 Census Test Usability Testing

IC 221984 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⚠️ Notice: This information collection may be referencing outdated material.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 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

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:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.