Information Collection

Usability Testing of CE Electronic Diary

IC 220548 under ICR 201408-1220-002 · OMB 1220-0141.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1220-0141 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Appendix B Interview Protocol Usability Testing of CE Electronic Diary	Form and Instruction
Form Appendix C Screenshots of Electronic Diary Usability Testing of CE Electronic Diary	Form
Form Appendix E Consent Form Usability Testing of CE Electronic Diary	Form and Instruction
Appendix B Interview Protocol Appendix B - Interview Protocol.docx	Form and Instruction
Appendix C Screenshots of Electronic Diary Appendix C - Screenshots of Electronic Diary.docx	Form
Appendix E Consent Form Appendix E - Consent Form.docx	Form and Instruction
Note to Reviewer - CE Electronic Diary Test (14Mar16).docx Note to Reviewer - CE Electronic Diary Test	IC Document

IC Title:

Usability Testing of CE Electronic Diary

Agency IC Tracking Number:

21608

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Appendix B	Yes	No	Printable Only
Form	Appendix C	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix E	Yes	No	Printable Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Note to Reviewer - CE Electronic Diary Test		03/14/2016

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

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