Information Collection

2019 AHS Housing Insecurity Cognitive Testing

IC 231933 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⚠️ Notice: This information collection may be referencing outdated material.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 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

IC Title:

2019 AHS Housing Insecurity 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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.