Information Collection

NSSRN Cognitive Testing

IC 224813 under ICR 201606-0607-003 · OMB 0607-0725.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

NSSRN Cognitive Testing

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.