Document Name Document Type
Form 3 ACS Respondent Burden Cognitive Testing Form and Instructi
1 Survey Questions Attachment F ACS Respondent Burden Testing Interviewer Administered Survey Questions.doc Form and Instruction
2 Roster Questions for Group 1 Attachment G Interviewer Administered Roster Questions (Group 1).doc Form and Instruction
3 Roster Questions for Group 2 Attachment H Interviewer Administered Roster Questions (Group 2).doc Form and Instruction
OMB Memo Weeks Worked, Income, YRNAT, YOE Spanish 06122017 .docx OMB Memo IC Document
Attachment A ACS Respondent Burden Testing Spanish Language Recruitment Plan_Screener_ Ad Flyer.docx Recruitment Plan, Recruitment Screener, and Recruitment Advertising Flyer IC Document
Attachment B ACS Respondent Burden Testing Spanish Language Consent Form.doc Consent Form IC Document
Attachment C ACS Respondent Burden Testing Spanish Language Protocol Group 1 Version 1.docx Cognitive Interview Protocol (Group 1, Version 1) IC Document
Attachment D ACS Respondent Burden Testing Spanish Language Protocol Group 1 Version 2 (1).docx Cognitive Interview Protocol (Group 1, Version 2) IC Document
Attachment E ACS Respondent Burden Testing Spanish Language Protocol Group 2.docx Cognitive Interview Protocol (Group 2) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	ACS Respondent Burden 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	Available Electronically?	Electronic Capability
Form and Instruction	3	Roster Questions for Group 2	Attachment H Interviewer Administered Roster Questions (Group 2).doc	No	Fillable Fileable
Form and Instruction	1	Survey Questions	Attachment F ACS Respondent Burden Testing Interviewer Administered Survey Questions.doc	No	Fillable Fileable
Form and Instruction	2	Roster Questions for Group 1	Attachment G Interviewer Administered Roster Questions (Group 1).doc	No	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24	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	24	24
Annual IC Time Burden (Hours)	58	58
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo	OMB Memo Weeks Worked, Income, YRNAT, YOE Spanish 06122017 .docx	06/12/2017
Recruitment Plan, Recruitment Screener, and Recruitment Advertising Flyer	Attachment A ACS Respondent Burden Testing Spanish Language Recruitment Plan_Screener_ Ad Flyer.docx	06/12/2017
Consent Form	Attachment B ACS Respondent Burden Testing Spanish Language Consent Form.doc	06/12/2017
Cognitive Interview Protocol (Group 1, Version 1)	Attachment C ACS Respondent Burden Testing Spanish Language Protocol Group 1 Version 1.docx	06/12/2017
Cognitive Interview Protocol (Group 1, Version 2)	Attachment D ACS Respondent Burden Testing Spanish Language Protocol Group 1 Version 2 (1).docx	06/12/2017
Cognitive Interview Protocol (Group 2)	Attachment E ACS Respondent Burden Testing Spanish Language Protocol Group 2.docx	06/12/2017

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

ACS Respondent Burden Cognitive Testing