Census Test Usability Testing Addendum

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⚠️ Notice: This information collection may be referencing outdated material.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 1 Census Test Usability Testing Addendum Form and Instructi
Enclosure 2 Mailing Materials.pdf Instruction
1 Instrument Debriefing Screens Enclosure 3 Placeholder screens for debriefing.pptx Form and Instruction
2 Demographics Questionnaire Enclosure 4 2017 CT Demographics.docx Form and Instruction
3 Mobile Experience Questionnaire Enclosure 5 2017 CT Mobile Experience Questionnaire.docx Form and Instruction
4 Satisfaction Questionnaire Enclosure 6 2017 CT Satisfaction questionnaire.docx Form and Instruction
OMB Letter Addendum.docx OMB Memo IC Document
Enclosure 1 Protocol.docx Protocol IC Document
Enclosure 7 Screener.docx Screener IC Document
Enclosure 8 RTI Consent Form.docx Consent Form IC Document
Enclosure 9 Login Card.docx Login Card IC Document
Enclosure 10 Approved memo from 2017 testing.docx Approved memo from 2017 testing IC Document

Information Collection (IC) Details

IC Title:	Census Test Usability Testing Addendum	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	1	Instrument Debriefing Screens	Enclosure 3 Placeholder screens for debriefing.pptx	No	Fillable Fileable
Instruction			Enclosure 2 Mailing Materials.pdf	No	Fillable Fileable
Form and Instruction	2	Demographics Questionnaire	Enclosure 4 2017 CT Demographics.docx	No	Fillable Fileable
Form and Instruction	4	Satisfaction Questionnaire	Enclosure 6 2017 CT Satisfaction questionnaire.docx	No	Fillable Fileable
Form and Instruction	3	Mobile Experience Questionnaire	Enclosure 5 2017 CT Mobile Experience Questionnaire.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: 216	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	216	216
Annual IC Time Burden (Hours)	384	384
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo	OMB Letter Addendum.docx	06/11/2018
Protocol	Enclosure 1 Protocol.docx	06/11/2018
Screener	Enclosure 7 Screener.docx	06/11/2018
Consent Form	Enclosure 8 RTI Consent Form.docx	06/11/2018
Login Card	Enclosure 9 Login Card.docx	06/11/2018
Approved memo from 2017 testing	Enclosure 10 Approved memo from 2017 testing.docx	06/11/2018

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