Formative Research to Investigate a Web Panel and to Determine Feasibility of Web-Based Cognitive Pretesting

Questionnaire Cognitive Interviewing and Pretesting (NCI)

Documents and Forms

Document Name Document Type
Form 1 Formative Research to Investigate a Web Panel and to Determine Feasibility of Web-Based Cognitive Pretesting Form and Instruction
1 Appendix A Screenshots Condition 1 Appendix A Screenshots Condition 1.docx Form and Instruction
2 Appendix B Screenshots Condition 2 Appendix B Screenshots Condition 2.doc Form and Instruction
Mini SSA Final.docx Mini SSA IC Document
Mini SSB Final 3.23.2016.docx Mini SSB IC Document
Appendix C OHSRP Exemption.pdf Appendix C OHSRP Exemption IC Document

Information Collection (IC) Details

IC Title:	Formative Research to Investigate a Web Panel and to Determine Feasibility of Web-Based Cognitive Pretesting	Agency IC Tracking Number:

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
Form and Instruction	1	Appendix A Screenshots Condition 1	Appendix A Screenshots Condition 1.docx		Yes	Yes	Fillable Fileable
Form and Instruction	2	Appendix B Screenshots Condition 2	Appendix B Screenshots Condition 2.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Mini SSA	Mini SSA Final.docx	03/23/2016
Mini SSB	Mini SSB Final 3.23.2016.docx	03/23/2016
Appendix C OHSRP Exemption	Appendix C OHSRP Exemption.pdf	03/23/2016

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