NSSRN Cognitive Testing

Generic Clearance for Questionnaire Pretesting Research

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0725 can be found here:

Documents and Forms

Document Name Document Type
Form Screener NSSRN Cognitive Testing Form
Questionnaire Questionnaire NSSRN Questionnaire_12082016.docx Form and Instruction
Screener Screener Screener_NSSRN.docx Form
OMB Memo_NSSRN_revised.docx OMB Memo IC Document
Protocol for NSSRN Cognitive Testing_12082016.docx Protocol IC Document

Information Collection (IC) Details

IC Title:	NSSRN Cognitive Testing	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	Screener	Screener	Screener_NSSRN.docx		No		Fillable Fileable
Form and Instruction	Questionnaire	Questionnaire	NSSRN Questionnaire_12082016.docx		No		Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	26	26
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo	OMB Memo_NSSRN_revised.docx	12/13/2016
Protocol	Protocol for NSSRN Cognitive Testing_12082016.docx	12/13/2016

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