2019 AHS Housing Insecurity Cognitive Testing

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⚠️ Notice: This information collection may be referencing outdated material.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 2019 AHS Housing Insecurity Cognitive Testing Form and Instructi
1 Protocol and Questionnaire Enclosure 1 - AHS 2019 Protocol_Housing Insecurity_FINAL_06252018.docx Form and Instruction
OMB Memo_AHS Housing Insecurity_FINAL_07252018.docx OMB Memo IC Document
Enclosure 2 - Recruitment Screener_Housing Inseciruty_FINAL_07252018.docx Recruitment Screener IC Document
Enclosure 3 - Recruitment Email_Housing Insecurity_FINAL_06252018.docx Recruitment Email IC Document
Enclosure 4 - Consent Form_AHS Housing Insecurity_FINAL_ 06252018.docx Consent Form IC Document

Information Collection (IC) Details

IC Title:	2019 AHS Housing Insecurity 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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Protocol and Questionnaire	Enclosure 1 - AHS 2019 Protocol_Housing Insecurity_FINAL_06252018.docx		No		Fillable Fileable

Line of Business: General Government

Subfunction: Central Property Management

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 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo	OMB Memo_AHS Housing Insecurity_FINAL_07252018.docx	07/25/2018
Recruitment Screener	Enclosure 2 - Recruitment Screener_Housing Inseciruty_FINAL_07252018.docx	07/25/2018
Recruitment Email	Enclosure 3 - Recruitment Email_Housing Insecurity_FINAL_06252018.docx	06/25/2018
Consent Form	Enclosure 4 - Consent Form_AHS Housing Insecurity_FINAL_ 06252018.docx	06/25/2018

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