Information Collection

App G_Cognitive Laboratory Survey

IC 219906 under ICR 201601-0920-018 · OMB 0920-0822.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0822 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
App E_Study Consent Form.docx App E_Study Consent Form	IC Document
App F_Study Interview Protocol.docx App F_Study Protocol	IC Document

IC Title:

App G_Cognitive Laboratory Survey

Agency IC Tracking Number:

16LV

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 3 CFR 241

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

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

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	30	30
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
App E_Study Consent Form	App E_Study Consent Form.docx	01/29/2016
App F_Study Protocol	App F_Study Interview Protocol.docx	01/29/2016

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