Information Collection

ACS Respondent Burden Cognitive Testing

IC 227164 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⚠️ Notice: This information collection may be referencing outdated material.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 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

IC Title:

ACS Respondent Burden 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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.