2017 American Community Survey (ACS) Revised Mailing Materials Cognitive Interviews

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0690-0030 can be found here:

Documents and Forms

Document Name Document Type
Attachment IV - Consent Form.docx Other-Consent Form
Attachment V - Recruitment Eligibility Screeners.docx Other-Recruitment Eligibility Screen
ACS-M ACS Revised Mailing Material Protocol Attachment III - ACS Revised Mailing Materials Protocol.docx Form and Instruction
Attachment I - 2017 ACS Revised Mailing Materials.pdf ACS Mailing Material IC Document
Attachment II - Recruitment Advertisements.pdf Recruitment Advertisements IC Document
ACS Mail Materials OMB Memo_FINAL 102616.docx OMB Memo IC Document

Information Collection (IC) Details

IC Title:	2017 American Community Survey (ACS) Revised Mailing Materials Cognitive Interviews	Agency IC Tracking Number:	Census

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Consent Form			Attachment IV - Consent Form.docx	Yes	No	Fillable Printable
Other-Recruitment Eligibility Screeners			Attachment V - Recruitment Eligibility Screeners.docx	Yes	No	Fillable Fileable
Form and Instruction	ACS-M	ACS Revised Mailing Material Protocol	Attachment III - ACS Revised Mailing Materials Protocol.docx	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 140	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	140	140
Annual IC Time Burden (Hours)	39	39
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
ACS Mailing Material	Attachment I - 2017 ACS Revised Mailing Materials.pdf	11/02/2016
Recruitment Advertisements	Attachment II - Recruitment Advertisements.pdf	11/02/2016
OMB Memo	ACS Mail Materials OMB Memo_FINAL 102616.docx	11/02/2016

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