Information Collection

Cognitive Testing of ASPE Criminal Justice System Questions

IC 229527 under ICR 201506-0920-003 · OMB 0920-0222.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 1a - Instrument 092117.docx	Other-WORD
Attachment 3 - Telephone Screener 092117.docx	Other-WORD
Attachment 1b- Item Justification 092117.docx Att 1b_Survey Questions Reference/Justification	IC Document
Attachment 2 - AdvFlyer 092117.docx Att 2_Advertisement Flyer	IC Document
Attachment 4 - Resp Data Collect Sheet 092117.docx Att 4_Respondent Data Collection Sheet	IC Document
Attachment 5 - Informed Consent 092117.docx Att 5_Adult Informed Consent	IC Document
Attachment 6 - Thank You Letter.docx Att 6_Thank you letter	IC Document
10-day letter ASPE Criminal Justice 121917.docx 10 day Letter	IC Document

IC Title:

Cognitive Testing of ASPE Criminal Justice System Questions

Agency IC Tracking Number:

0920-0222 (18JY)

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Attachment 1a - Instrument 092117.docx		No		Paper Only
Other-WORD			Attachment 3 - Telephone Screener 092117.docx		No		Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of th US Population

FR Citation: 49 FR 37693

Number of Respondents: 117

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	117	117
Annual IC Time Burden (Hours)	45	45
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 1b_Survey Questions Reference/Justification	Attachment 1b- Item Justification 092117.docx	12/20/2017
Att 2_Advertisement Flyer	Attachment 2 - AdvFlyer 092117.docx	12/20/2017
Att 4_Respondent Data Collection Sheet	Attachment 4 - Resp Data Collect Sheet 092117.docx	12/20/2017
Att 5_Adult Informed Consent	Attachment 5 - Informed Consent 092117.docx	12/20/2017
Att 6_Thank you letter	Attachment 6 - Thank You Letter.docx	12/20/2017
10 day Letter	10-day letter ASPE Criminal Justice 121917.docx	01/02/2018

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