Older Americans Placemat Usability Testing

Generic Information Collection Plan for the Collection of Qualitative Feedback on Bureau Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3170-0024 can be found here:

Documents and Forms

Document Name Document Type
Moderators Guide_OMB.pdf Other-Moderator Guide
IC Template 3170-0024_Placemat Program_OMB.pdf IC Submission Template IC Document
MOW_placemat_fill_in_blanks.pdf MOW_placemat_fill_in_blanks (Item Tested) IC Document
MOW_placemat_word_scramble.pdf MOW_placemat_word_scramble (Item Tested) IC Document
MOW_placemat_word_search.pdf MOW_placemat_word_search (Item Tested) IC Document

Information Collection (IC) Details

IC Title:	Older Americans Placemat Usability Testing	Agency IC Tracking Number:	DI 00502

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Moderator Guide			Moderators Guide_OMB.pdf		No		Printable Only

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 80	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	80	80
Annual IC Time Burden (Hours)	26	26
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
IC Submission Template	IC Template 3170-0024_Placemat Program_OMB.pdf	06/21/2017
MOW_placemat_fill_in_blanks (Item Tested)	MOW_placemat_fill_in_blanks.pdf	06/21/2017
MOW_placemat_word_scramble (Item Tested)	MOW_placemat_word_scramble.pdf	06/21/2017
MOW_placemat_word_search (Item Tested)	MOW_placemat_word_search.pdf	06/21/2017

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