Information Collection

Older Americans Placemat Usability Testing

IC 227199 under ICR 201509-3170-002 · OMB 3170-0024.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.