Information Collection

2014 Individual Diary Pilot Test

IC 209933 under ICR 201401-1220-001 · OMB 1220-0050.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1220-0050 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment B(a) 2014 Individual Diary Pilot Test	Form
Attachment B(a) Screenshots of Web Diary Attachment B (a) - ChangePasswordMobile.jpg	Form
Attachment B (b) Screenshot of Web Diary Attachment B (b) - LogInMobile.jpg	Form
Attachment B (c) Screenshot of Web Diary Attachment B (c) - LogInWebDiary.jpg	Form
Attachment B (c) Screenshot of Web Diary Attachment B (c) -WebDiaryClothingShoesAccessories.jpg	Form
Attachment B (d) Screenshot of Web Diary Attachment B (d) -MobileAddAnExpense.jpg	Form
Attachment B (e) Screenshot of Web Diary Attachment B (e) -MobileClothingJewelryAccessories.jpg	Form
Attachment B (e) Screenshot of Web Diary Attachment B (e) -MobileContinuetoSummaryScreen.jpg	Form
Attachment B (e) Screenshot of Web Diary Attachment B (f) -MobileFoodAwayFromHome.jpg	Form
Attachment B (g) Screenshot of Web Diary Attachment B (g) -MobileFoodDrinkHomeConsumption.jpg	Form
Attachment B (h) Screenshot of Web Diary Attachment B (h) - MobileLogOutScreen.jpg	Form
Attachment B (i) Screenshot of Web Diary Attachment B (i) -MobileOtherProductsServices.jpg	Form
Attachment B (j) Screenshot of Web Diary Attachment B (j) - MobileSummaryofExpensesScreen.jpg	Form
Attachment B (k) Screenshot of Web Diary Attachment B (k) - WebDiaryAllOtherProductsSrvcs.jpg	Form
Attachment B (l) Screenshot of Web Diary Attachment B (l) - WebDiaryChangePasswordScreen.jpg	Form
Attachment B (m) Screenshot of Web Diary Attachment B (m) - WebDiaryFoodDrinkAwayHome.jpg	Form
Attachment B (n) Screenshot of Web Diary Attachment B (n) - WebDiaryFoodDrinkHomeConsumption.jpg	Form
Attachment B (o) Screenshot of Web Diary Attachment B (o) - WebDiaryLoggingOut.jpg	Form
Attachment B (p) Screenshot of Web Diary Attachment B (p) - WebDiaryStartDate.jpg	Form
Attachment B (q) Screenshot of Web Diary Attachment B (q) - WebDiarySubmit.jpg	Form
Attachment A - IDF_pilot_report_overview.doc Attachment A - Pilot Overview	IC Document
Attachment C (a) - Advanced Letter CE 803L 2013.pdf Advance Letter	IC Document
Attachment C (b) - IDFTRespondentUserGuideWebDiary_Final.doc Respondent User Guide	IC Document
Attachment C (c) - IDMobile FR Talking Points_Usability Test.docx Talking Points	IC Document
Attachment C (d) - IDWebDiaryFRTalkingPoints_Final.docx Talking Points	IC Document
Attachment C (e) - Mobile Diary Pamphlet 5Dec2013.docx Pamphlet	IC Document
Attachment D - CE Mobile Diary Phase I Testing Report (7-29-2013).docx Phase I Testing Report	IC Document
Attachment E - Individual diary analysis plan_07_09_13.docx Analysis Plan	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

2014 Individual Diary Pilot Test

Agency IC Tracking Number:

Is this a Common Form? No

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	Attachment B(a)	Screenshots of Web Diary	Attachment B (a) - ChangePasswordMobile.jpg	Yes	Yes	Fillable Fileable
Form	Attachment B (b)	Screenshot of Web Diary	Attachment B (b) - LogInMobile.jpg	Yes	Yes	Fillable Fileable
Form	Attachment B (c)	Screenshot of Web Diary	Attachment B (c) - LogInWebDiary.jpg	Yes	Yes	Fillable Fileable
Form	Attachment B (c)	Screenshot of Web Diary	Attachment B (c) -WebDiaryClothingShoesAccessories.jpg	Yes	Yes	Fillable Fileable
Form	Attachment B (d)	Screenshot of Web Diary	Attachment B (d) -MobileAddAnExpense.jpg	Yes	Yes	Fillable Fileable
Form	Attachment B (e)	Screenshot of Web Diary	Attachment B (e) -MobileClothingJewelryAccessories.jpg	Yes	Yes	Fillable Fileable
Form	Attachment B (e)	Screenshot of Web Diary	Attachment B (e) -MobileContinuetoSummaryScreen.jpg	Yes	Yes	Fillable Fileable
Form	Attachment B (e)	Screenshot of Web Diary	Attachment B (f) -MobileFoodAwayFromHome.jpg	Yes	Yes	Fillable Fileable
Form	Attachment B (g)	Screenshot of Web Diary	Attachment B (g) -MobileFoodDrinkHomeConsumption.jpg	Yes	Yes	Fillable Fileable
Form	Attachment B (h)	Screenshot of Web Diary	Attachment B (h) - MobileLogOutScreen.jpg	Yes	Yes	Fillable Fileable
Form	Attachment B (i)	Screenshot of Web Diary	Attachment B (i) -MobileOtherProductsServices.jpg	Yes	Yes	Fillable Fileable
Form	Attachment B (j)	Screenshot of Web Diary	Attachment B (j) - MobileSummaryofExpensesScreen.jpg	Yes	Yes	Fillable Fileable
Form	Attachment B (k)	Screenshot of Web Diary	Attachment B (k) - WebDiaryAllOtherProductsSrvcs.jpg	Yes	Yes	Fillable Fileable
Form	Attachment B (l)	Screenshot of Web Diary	Attachment B (l) - WebDiaryChangePasswordScreen.jpg	Yes	Yes	Fillable Fileable
Form	Attachment B (m)	Screenshot of Web Diary	Attachment B (m) - WebDiaryFoodDrinkAwayHome.jpg	Yes	Yes	Fillable Fileable
Form	Attachment B (n)	Screenshot of Web Diary	Attachment B (n) - WebDiaryFoodDrinkHomeConsumption.jpg	Yes	Yes	Fillable Fileable
Form	Attachment B (o)	Screenshot of Web Diary	Attachment B (o) - WebDiaryLoggingOut.jpg	Yes	Yes	Fillable Fileable
Form	Attachment B (p)	Screenshot of Web Diary	Attachment B (p) - WebDiaryStartDate.jpg	Yes	Yes	Fillable Fileable
Form	Attachment B (q)	Screenshot of Web Diary	Attachment B (q) - WebDiarySubmit.jpg	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 48

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	48	48
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment A - Pilot Overview	Attachment A - IDF_pilot_report_overview.doc	01/08/2014
Advance Letter	Attachment C (a) - Advanced Letter CE 803L 2013.pdf	01/08/2014
Respondent User Guide	Attachment C (b) - IDFTRespondentUserGuideWebDiary_Final.doc	01/08/2014
Talking Points	Attachment C (c) - IDMobile FR Talking Points_Usability Test.docx	01/08/2014
Talking Points	Attachment C (d) - IDWebDiaryFRTalkingPoints_Final.docx	01/08/2014
Pamphlet	Attachment C (e) - Mobile Diary Pamphlet 5Dec2013.docx	01/08/2014
Phase I Testing Report	Attachment D - CE Mobile Diary Phase I Testing Report (7-29-2013).docx	01/08/2014
Analysis Plan	Attachment E - Individual diary analysis plan_07_09_13.docx	01/08/2014

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