Information Collection

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

IC 220759 under ICR 201511-0925-002 · OMB 0925-0589.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

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
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 %

table that charts list of burden
	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

table that charts IC Documents
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.