Information Collection

Census Test Usability Testing Addendum

IC 231218 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⚠️ Notice: This information collection may be referencing outdated material.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 1 Instrument Debriefing Screens Census Test Usability Testing Addendum	Form and Instruction
Form 2 Demographics Questionnaire Census Test Usability Testing Addendum	Form and Instruction
Form 3 Mobile Experience Questionnaire Census Test Usability Testing Addendum	Form and Instruction
Form 4 Satisfaction Questionnaire Census Test Usability Testing Addendum	Form and Instruction
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

IC Title:

Census Test Usability Testing Addendum

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.