Generic Clearance for Questionnaire Pretesting Research

Forms and Documents

Document Name	Status
Form 1 Annual Retail Trade Survey Cognitive Testing Form and Instructi	New
Form 1 NSCH Questionnaire Cognitive Interviews Form and Instructi	New
Form 1 NSCH Mail Materials Cognitive Testing Form and Instructi	New
Form 1 2020 Privacy & Confidentiality Cognitive Testing Form and Instructi	New
Form 1 Early Stage Scoping for the Commodity Flow Survey Form and Instructi	New
Form 1 NSP Usability Testing Form and Instructi	New
Form 1 Econ Record Keep Study Form and Instructi	New
Form 1 2020 CPEX Extending the Census Environment Cog Testing Form and Instructi	New
Form 1 2019 ABS Globalization Module Cognitive Testing Form and Instructi	New
Form 1 NYCHVS Cognitive Interviews Form and Instructi	New
Form 1 ASM Robotics Debriefings Form and Instructi	New
Form 1 CPS Food Security Supplement Form and Instructi	New
Form 1 2019 ABS Innovation Module Cognitive Testing Form and Instructi	New
Form 1 CEDSCI Usability Evaluation Addendum Form	New
Form 1 ACES Machine Learning Debriefings Form and Instructi	New
Form 1 UYC Cog Testing and Focus Groups Form and Instructi	New
Form 1 MEPS Cognitive Testing Form and Instructi	New
Form 1 Vacant Crowdsourcing Internet Study Form and Instructi	New
Form 4 2020 Tracking Survey Form and Instructi	New
Form 1 2020 Census Vacant Unit Crowdsourcing Research Form and Instructi	New
Form 1 2019 ACS POW-HOA Cognitive Testing to Reduce Burden Form and Instructi	New
Form 1 2019 SAS Telemedicine Cog Interviews Form	New
Form 1 National Survey of Psychiatrists Cognitive Testing Form and Instructi	New
Form 1 2019 Generic Screener with UYC Pilot Screener Form	New
Form 1 Quarterly Survey of Public Pensions Cognitive Testing Form and Instructi	New
Form 1 NSCH Screener Cognitive Interviews Form and Instructi	New
Form 1 SAS E-Commerce Respondent Debriefings Form	New
Form 1 ABS Telephone Respondent Debriefings Form and Instructi	New
Form 1 NAPCS Debriefings Form and Instructi	New
Form 1 MEPS Telephone Interviews Form and Instructi	New
Form 1 Addendum for IOE Mobile UI Project Phase 2 Form and Instructi	New
Form 1 2018 ABS Technology Module Cog Testing Form and Instructi	New
Form 1 2020 Respondent Privacy Cognitive Interviews Round 2 Form and Instructi	New
Form 1 BRDS Cognitive Testing Form and Instructi	New
Form 1 2019 AHS Housing Insecurity Cognitive Testing Form and Instructi	New
Form 1 ACS Respondent Comment/Feedback Addendum Form and Instructi	New
Form 1 2018 Census Test GQE eResponse Debriefings Form and Instructi	New
Form 1 Business Unit Harmonization Phase 3 Form and Instructi	New
Form 1 FGP Econ Census Respondent Debriefings Form	New
Form 1 Census Test Usability Testing Addendum Form and Instructi	New
Form 1 2018 ACS Respondent Burden Testing Form and Instructi	New
Form 1 2018 MOPS Hospitals Form and Instructi	New
Form 1 ACES Robotics Form and Instructi	New
Form 1 2017 Economic Census Debriefings Form and Instructi	New
Form 1 CEDSCI Usability Addendum Form	New
Form 1 2017 ABS Usability Testing Form	New
Form 1 2019 AHS Cognitive Testing Form and Instructi	New
Form 1 2018 NSCH Usability Evaluation Form and Instructi	New
Form 2 2018 BRDIS Cognitive Testing Form and Instructi	New
Form 2017 ACS form American Community Survey (ACS) Respondent Comment/Feedback Form	New
Form 1 2020 CBAMS Addendum Form and Instructi	New
Form 1 2018 Centurion Site Tutorial Videos Cog Testing Form	New
Form 1 Cognitive Testing of Privacy Act Language Form and Instructi	New
Form 1 MEPS–IC Cog Testing Form and Instructi	New
Form 1 ASM Robotics Form and Instructi	New
Form 1 BRDI-M Respondent Debriefings Form and Instructi	New
Form 1 2020 Respondent Privacy Cognitive Interviews Form and Instructi	New
Form 1 NSSRN Usability Evaluation Form and Instructi	New
Form 1 ACS Respondent Perceptions of Burden Form and Instructi	New
Form 1 CFS Debriefing Study Form and Instructi	New
Form 1 NSCH Questionnaire Cognitive Testing Form and Instructi	New
Form 1 Business Unit Harmonization Project Case Studies Addendum Form	New
Form 1 2017 Annual Survey of Businesses Cog Testing Form and Instructi	New
Form 3 ACS Respondent Burden Cognitive Testing Form and Instructi	New
Form 1 CBAMS Cognitive and Usability Interviews Form and Instructi	New
Form 1 Mobile UI Design Framework for Survey Operations – Phase 1, Study 2 Form and Instructi	New
Form BE-120 BE-120 Cognitive Interviews Form and Instructi	New
Form 1 2018 NCVS PPCS Cognitive Interviews Form	New
Form 1 2017 FNS Usability Testing Form and Instructi	New
Form 1 2017 Economic Census Usability Testing and Debriefs Form	New
Form 1 Business Unit Harmonization Project Case Studies Form	New
Form 1 2017 SAS Cognitive Interviews Form	New
Form 1 BE-125 Respondent Debriefings Form and Instructi	New
Form 1 ASPP Cognitive Interviews Form	New
Form 1 NAPCS Questionnaire Field Test Form and Instructi	New
Form Screener NSSRN Cognitive Testing Form	New
Form Demographic Inform CEDSCI Usability Evaluation Form	New
Form CPS CIU Roster Que Current Population Survey Computer and Internet Use (CPS CIU) Supplemental Test Form	New
Form Paper Survey Quest 2017 American Community Survey Respondent Burden Testing Form	New
Form Petroleum Construc 2017 Economic Census New Question Testing Addendum Form and Instructi	New
Form MEPS – IC Pretest Medical Expenditure Panel Survey – Insurance Component (MEPS-IC) Form and Instructi	New
Form Web Satisfaction Q Web Satisfaction Questionnaire Development Form and Instructi	New
Form Telephone Recruitm Recruitment Screener Form and Instructi	New
omb83-(0607-0725).pdf Supplementary Document	2016-06-08
KeyElements072015.docx Supplementary Document	2016-06-07
Attachment A.doc Supplementary Document	2016-06-07
16genclrpartB (format).doc Supporting Statement B	2016-06-07
16genclrpartA (format).doc Supporting Statement A	2016-06-07

IC Document Collections

IC ID	Document Title	Status
237219	Annual Retail Trade Survey Cognitive Testing Form and Instructi	New
237067	NSCH Questionnaire Cognitive Interviews Form and Instructi	New
236843	NSCH Mail Materials Cognitive Testing Form and Instructi	New
236827	2020 Privacy & Confidentiality Cognitive Testing Form and Instructi	New
236635	Early Stage Scoping for the Commodity Flow Survey Form and Instructi	New
236519	NSP Usability Testing Form and Instructi	New
236517	Econ Record Keep Study Form and Instructi	New
236498	2020 CPEX Extending the Census Environment Cog Testing Form and Instructi	New
236399	2019 ABS Globalization Module Cognitive Testing Form and Instructi	New
236358	NYCHVS Cognitive Interviews Form and Instructi	New
236294	ASM Robotics Debriefings Form and Instructi	New
236084	CPS Food Security Supplement Form and Instructi	New
236008	2019 ABS Innovation Module Cognitive Testing Form and Instructi	New
235998	CEDSCI Usability Evaluation Addendum Form	New
235997	ACES Machine Learning Debriefings Form and Instructi	New
235431	UYC Cog Testing and Focus Groups Form and Instructi	New
235377	MEPS Cognitive Testing Form and Instructi	New
235084	Vacant Crowdsourcing Internet Study Form and Instructi	New
234975	2020 Tracking Survey Form and Instructi	New
234858	2020 Census Vacant Unit Crowdsourcing Research Form and Instructi	New
234726	2019 ACS POW-HOA Cognitive Testing to Reduce Burden Form and Instructi	New
234426	2019 SAS Telemedicine Cog Interviews Form	New
234062	National Survey of Psychiatrists Cognitive Testing Form and Instructi	New
233847	2019 Generic Screener with UYC Pilot Screener Form	New
233636	Quarterly Survey of Public Pensions Cognitive Testing Form and Instructi	New
233477	NSCH Screener Cognitive Interviews Form and Instructi	New
233079	SAS E-Commerce Respondent Debriefings Form	New
233077	ABS Telephone Respondent Debriefings Form and Instructi	New
232899	NAPCS Debriefings Form and Instructi	New
232672	MEPS Telephone Interviews Form and Instructi	New
232518	Addendum for IOE Mobile UI Project Phase 2 Form and Instructi	New
232233	2018 ABS Technology Module Cog Testing Form and Instructi	New
231993	2020 Respondent Privacy Cognitive Interviews Round 2 Form and Instructi	New
231985	BRDS Cognitive Testing Form and Instructi	New
231933	2019 AHS Housing Insecurity Cognitive Testing Form and Instructi	New
231703	ACS Respondent Comment/Feedback Addendum Form and Instructi	New
231625	2018 Census Test GQE eResponse Debriefings Form and Instructi	New
231522	Business Unit Harmonization Phase 3 Form and Instructi	New
231455	FGP Econ Census Respondent Debriefings Form	New
231218	Census Test Usability Testing Addendum Form and Instructi	New
231191	2018 ACS Respondent Burden Testing Form and Instructi	New
231154	2018 MOPS Hospitals Form and Instructi	New
231153	ACES Robotics Form and Instructi	New
230846	2017 Economic Census Debriefings Form and Instructi	New
230569	CEDSCI Usability Addendum Form	New
230478	2017 ABS Usability Testing Form	New
230292	2019 AHS Cognitive Testing Form and Instructi	New
230290	2018 NSCH Usability Evaluation Form and Instructi	New
230041	2018 BRDIS Cognitive Testing Form and Instructi	New
229783	American Community Survey (ACS) Respondent Comment/Feedback Form	New
228752	2020 CBAMS Addendum Form and Instructi	New
228748	2018 Centurion Site Tutorial Videos Cog Testing Form	New
228701	Cognitive Testing of Privacy Act Language Form and Instructi	New
228585	MEPS–IC Cog Testing Form and Instructi	New
228429	ASM Robotics Form and Instructi	New
227924	BRDI-M Respondent Debriefings Form and Instructi	New
227899	2020 Respondent Privacy Cognitive Interviews Form and Instructi	New
227896	NSSRN Usability Evaluation Form and Instructi	New
227780	ACS Respondent Perceptions of Burden Form and Instructi	New
227726	2017 PRA Testing Instruction	New
227425	CFS Debriefing Study Form and Instructi	New
227344	NSCH Questionnaire Cognitive Testing Form and Instructi	New
227236	Business Unit Harmonization Project Case Studies Addendum Form	New
227178	2017 Annual Survey of Businesses Cog Testing Form and Instructi	New
227164	ACS Respondent Burden Cognitive Testing Form and Instructi	New
226990	CBAMS Cognitive and Usability Interviews Form and Instructi	New
226988	Mobile UI Design Framework for Survey Operations – Phase 1, Study 2 Form and Instructi	New
226951	BE-120 Cognitive Interviews Form and Instructi	New
226802	2018 NCVS PPCS Cognitive Interviews Form	New
226491	2017 NCVS Mail Materials Project Instruction	New
226079	2017 FNS Usability Testing Form and Instructi	New
225780	2017 Economic Census Usability Testing and Debriefs Form	New
225625	Business Unit Harmonization Project Case Studies Form	New
225543	2017 SAS Cognitive Interviews Form	New
224969	BE-125 Respondent Debriefings Form and Instructi	New
224930	ASPP Cognitive Interviews Form	New
224845	NAPCS Questionnaire Field Test Form and Instructi	New
224813	NSSRN Cognitive Testing Form	New
224374	CEDSCI Usability Evaluation Form	New
224275	Current Population Survey Computer and Internet Use (CPS CIU) Supplemental Test Form	New
224169	2017 American Community Survey Respondent Burden Testing Form	New
223989	2017 Economic Census New Question Testing Addendum Form and Instructi	New
223608	Pretest Medical Expenditure Panel Survey – Insurance Component (MEPS-IC) Form and Instructi	New
222450	Web Satisfaction Questionnaire Development Form and Instructi	New
221822	Recruitment Screener Form and Instructi	New

ICR Details

OMB Control No: 0607-0725	ICR Reference No: 201606-0607-003
Status: Historical Active	Previous ICR Reference No: 201312-0607-004
Agency/Subagency: DOC/CENSUS	Agency Tracking No:
Title: Generic Clearance for Questionnaire Pretesting Research
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/09/2016
	Date Received in OIRA: 07/28/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2019	36 Months From Approved	09/30/2016
Responses	16,500	0	16,500
Time Burden (Hours)	16,500	0	16,500
Cost Burden (Dollars)	0	0	0

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Abstract: The research will be used by the Census Bureau and the survey sponsors to improve questionnaires and procedures, reduce respondent burden, and ultimately increase the quality of data collected in Census Bureau censuses and surveys.

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Authorizing Statute(s): US Code: 13 USC 131, 141, 161, 181, 182, 193, Name of Law: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 28929	11/13/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 32720	05/24/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 85

IC Title	Form No.	Form Name
Mobile UI Design Framework for Survey Operations – Phase 1, Study 2	1, 2	Experimental Info ,   Privacy Act Statement
Current Population Survey Computer and Internet Use (CPS CIU) Supplemental Test	CPS CIU Roster Questionnaire, CPS CIU Full Questionnaire	CPS CIU Roster Questionnaire ,   CPS CIU Full Questionnaire
BRDI-M Respondent Debriefings	1	Protocol
ACS Respondent Burden Cognitive Testing	1, 2, 3	Roster Questions for Group 2 ,   Survey Questions ,   Roster Questions for Group 1
CBAMS Cognitive and Usability Interviews	2, 1, 3	Paper Questionnaire ,   Demographics Questionnaire ,   Usability Satisfaction Questionnaire
2020 CBAMS Addendum	2, 1	Demographic Questionnaire ,   Internet and Mobile Experience Questionnaire
American Community Survey (ACS) Respondent Comment/Feedback	2017 ACS form, Comment and Feedback Question	2017 ACS form ,   Comment and Feedback Question
BRDS Cognitive Testing	2, 1	Aritificial Intelligence Questionnaire ,   Leased / Temporary Employees Questionnaire
2020 Respondent Privacy Cognitive Interviews Round 2	1	Privacy and Confidentiality Questionnaire
MEPS Cognitive Testing	4, 3, 1, 2	Form MEPS 10 ,   Form MEPS 10s ,   Form MEPS 11 ,   Form MEPS 11s
Econ Record Keep Study	1, 2	Example Chart ,   Example Survey Questions
NSP Usability Testing	1, 2, 3, 4, 5	Log On Letter ,   Paper Questionnaire ,   Demographic Questionnaire ,   Mobile Experience Questionnaire ,   Satisfaction Questionnaire
BE-125 Respondent Debriefings	1	Questionnaire
2017 Annual Survey of Businesses Cog Testing	1	Annual Survey of Businesses Questionnaire
2017 PRA Testing
2018 NSCH Usability Evaluation	4, 5, 1, 2, 3, 6	Questionnaire V1 ,   Questionnaire V2 ,   Questionnaire V3 ,   Questionnaire V4 ,   Demographic Questionnaire ,   Satisfaction Questionnaire
BE-120 Cognitive Interviews	BE-120 V1, BE-120 V2, BE-120	Questionnaire ,   Version 1 Supplement ,   Version 2 Supplement
Cognitive Testing of Privacy Act Language	1, 2	Privacy Act Test Language and FAQ Context ,   Confidentiality Statements in English
Addendum for IOE Mobile UI Project Phase 2	1	Test materials as seen by respondents
CEDSCI Usability Evaluation Addendum	4, 3, 1, 2	Demographics Questionnaire ,   Internet Use Questionnaire ,   Debriefing Questionnaire ,   Satisfaction Questionnaire
UYC Cog Testing and Focus Groups	1, 2	Focus Group Protocol ,   Cognitive Interviewing Protocol
Annual Retail Trade Survey Cognitive Testing	1	Select Survey Items
2018 NCVS PPCS Cognitive Interviews	1	Full Questionnaire
2017 NCVS Mail Materials Project
CEDSCI Usability Evaluation	Demographic Information, Debriefing Question, Internet and Smartphone Experience Questions	Demographic Information ,   Internet and Smartphone Experience Questions ,   Debriefing Question
2017 Economic Census New Question Testing Addendum	Petroleum Construction Natural Gas Questions	Petroleum Construction Natural Gas Questions
2020 Respondent Privacy Cognitive Interviews	1	Privacy Concerns Questionnaire
CEDSCI Usability Addendum	1, 2, 3, 4	Demographic Questionnaire ,   Internet Experience Questionnaire ,   Debriefing Questionnaire ,   Satisfaction Questionnaire
2018 BRDIS Cognitive Testing	4, 2, 3, 1	Geography Questions ,   Consent Form ,   BRDIS 2016 ,   Capitol Stock Questions
ACES Robotics	1	Question
2018 MOPS Hospitals	1	Questionnaire
2020 Tracking Survey	3, 1, 2, 4, 5, 6	Web Probe Testing - Language Questions for Web ,   Web Probe Testing - Screencap of Introduction to Web Survey ,   Web Probe Testing - Screencaps of Web Testing ,   Cog Testing - Census Tracking Questionnaire ,   Cog Testing - Web Form of Census Tracking Questionnaire ,   Cog Testing - Demographics Questionnaire
NSCH Screener Cognitive Interviews	1, 4, 8, 11, 2, 3, 5, 6, 7, 9, 10	Screener Card ,   Experimental Treatment B - NonPerforated Mockup 1 ,   Experimental Treatment B - NonPerforated Mockup 2 ,   Experimental Treatment B - Perforated Mockup 1 ,   Experimental Treatment B - Perforated Mockup 2 ,   Experimental Treatment C ,   Standard Treatments A and D ,   NonPerforated Mockup 1 ,   NonPerforated Mockup 2 ,   Perforated Mockup 1 ,   Perforated Mockup 2
ACES Machine Learning Debriefings	1	Screenshots of Instrument
2019 ABS Globalization Module Cognitive Testing	1	Globalization Module draft
2017 SAS Cognitive Interviews	1	Draft Questions
2017 Economic Census Usability Testing and Debriefs	1, 2, 3	Demographics Questionnaire ,   Computer Use and Internet Experience Questionnaire ,   Satisfaction Questionnaire
2018 ABS Technology Module Cog Testing	3, 1, 2	ABS Questionnaire ,   ABS R and D Questionnaire ,   Attachment D - Technology Module Questionnaire
2018 Census Test GQE eResponse Debriefings	3, 1, 2, 4	2018 GQE eResponse Site ,   eResponse Reporting Template ,   Invitation Letter ,   eResponse User Manual
NSSRN Usability Evaluation	2, 3, 4, 1	Demographics Questionnaire ,   Debriefing Questions ,   Satisfaction Questionnaire ,   NSSRN Questionnaire
Business Unit Harmonization Phase 3	1	BUH MockUp
2020 Census Vacant Unit Crowdsourcing Research	1	Online Instrument
ABS Telephone Respondent Debriefings	1	2017 ABS Questionnaire
2019 ACS POW-HOA Cognitive Testing to Reduce Burden	1	Modified ACS Paper Form
ASM Robotics Debriefings	1	Robotics Questions
NAPCS Questionnaire Field Test	2, 1	Questionnaire ,   Debriefing
Web Satisfaction Questionnaire Development	Web Satisfaction Questionnaire	Web Satisfaction Questionnaire
CFS Debriefing Study	1	Questionnaire
2018 Centurion Site Tutorial Videos Cog Testing	2, 1, 3	Video Screenshots ,   Usability Tasks ,   Video Satisfaction Questionnare
2019 AHS Cognitive Testing	1	Protocol and Questionnaire
FGP Econ Census Respondent Debriefings	1	FGP Questions from Econ Census
NAPCS Debriefings	1	NAPCS Instrument Screens
Vacant Crowdsourcing Internet Study	5, 6, 9, 7, 1, 2, 4, 3, 8	Mailing Materials ,   Version 1 of Address Display ,   Version 2 of Address Display ,   Version 3 of Address Display ,   Version 4 of Address Display ,   Version 5 of Address Display ,   Version 6 of Address Display ,   Satisfaction with Instrument Questionnaire ,   Preference of Address Display Question
Early Stage Scoping for the Commodity Flow Survey	1	2017 CFS Instrument
NYCHVS Cognitive Interviews	3, 2, 1	Protocol V1 (Owner) ,   Protocol V2 (Renter) ,   Flash Cards
2017 FNS Usability Testing	1	Application
Pretest Medical Expenditure Panel Survey – Insurance Component (MEPS-IC)	MEPS – IC	Medical Expenditure Panel Survey – Insurance Component (MEPS-IC)
ACS Respondent Perceptions of Burden	2, 1	Paper Survey ,   Follow Up Questions
ASM Robotics	1, 3, 4, 2	Version A Questions ,   Version B Questions ,   Version C Questions ,   Version D Questions
ACS Respondent Comment/Feedback Addendum	1, 2	Entire ACS Questionnaire ,   ACS Respondent Feedback items at end of ACS Questionnaire
2019 AHS Housing Insecurity Cognitive Testing	1	Protocol and Questionnaire
2020 Privacy & Confidentiality Cognitive Testing	6, 1, 2, 3, 4, 5	2020 Census Draft w/ citizenship ,   2020 Census Draft w/o citizenship ,   2020 Census Follow Up Survey w/ citizenship ,   Online Questionnaire w/ citizenship ,   Online Questionnaire w/o citizenship ,   2020 Census Follow Up Survey w/o citizenship
NSSRN Cognitive Testing	Questionnaire, Screener	Screener ,   Questionnaire
MEPS–IC Cog Testing	4, 1, 2, 3	MEPS-10 ,   MEPS-10S ,   MEPS-11 ,   MEPS-11S
National Survey of Psychiatrists Cognitive Testing	1, 2, 4, 3	Questionnaire ,   Alternative Full page Coversheet w/ Questionnaire (beginning) ,   Alternative Cover Image 1 ,   Alternative Cover Image 2
MEPS Telephone Interviews	1, 3, 4, 2	2018 MEPS-10 Form ,   2018 MEPS-10S Form ,   2017 MEPS-10 Form ,   2017 MEPS-10S Form
SAS E-Commerce Respondent Debriefings	1	E-Commerce Questions
2019 Generic Screener with UYC Pilot Screener	1	Screeners part A and part B
CPS Food Security Supplement	1	Protocol and Questionnaire
NSCH Questionnaire Cognitive Interviews	4, 3, 2, 1	Screener Survey ,   Cognitive Interview Version 1 ,   Cognitive Interview Version 3 ,   Cognitive Interview Version 2
Business Unit Harmonization Project Case Studies Addendum	1	Protocol
2017 American Community Survey Respondent Burden Testing	Interviewer-Administered Survey Questions, Paper Survey Questions, Interviewer-Administered Roster Questions	Paper Survey Questions ,   Interviewer-Administered Survey Questions ,   Interviewer-Administered Roster Questions
ASPP Cognitive Interviews	1	Questionnaire
Business Unit Harmonization Project Case Studies	1	Protocol
Recruitment Screener	Internet Screener, Telephone Recruitment Screener	Telephone Recruitment Screener ,   Internet Screener
Census Test Usability Testing Addendum	2, 1, 3, 4	Instrument Debriefing Screens ,   Demographics Questionnaire ,   Satisfaction Questionnaire ,   Mobile Experience Questionnaire
2018 ACS Respondent Burden Testing	1, 3, 2	ACS Questionnaire Up to Q28 ,   ACS Questionnaire From Q29 V1 ,   ACS Questionnaire From Q29 V2
2017 ABS Usability Testing	1	Instrument screenshots
NSCH Questionnaire Cognitive Testing	3, 4, 6, 7, 8, 1, 2, 5	English Screener ,   English Topical Questionnaire 1 ,   English Topical Questionnaire 2 ,   English Topical Questionnaire 3 ,   Spanish Screener ,   Spanish Topical Questionnaire 1 ,   Spanish Topical Questionnaire 2 ,   Spanish Topical Questionnaire 3
2017 Economic Census Debriefings	1	Econ Census Web Screens
2019 SAS Telemedicine Cog Interviews	1, 2	Attachment A - Proposed Telemedicine Questions for SAS ,   Attachment C - SAS Questionnaire
Quarterly Survey of Public Pensions Cognitive Testing	1	QSPP Draft Questionnaire
NSCH Mail Materials Cognitive Testing	1	Mail Materials
2019 ABS Innovation Module Cognitive Testing	1, 2, 3, 4, 5, 6	Revised Innovation Module ,   Innovation Handout ,   Barriers and Drivers Handout ,   Business Strategies Handout ,   Digital Tech Cards ,   Tech Capabilities List
2020 CPEX Extending the Census Environment Cog Testing	1	Mailing Materials

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	16,500	16,500	0	0	0	0
Annual Time Burden (Hours)	16,500	16,500	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/28/2016

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