Information Collection

National Survey of Psychiatrists Cognitive Testing

IC 234062 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⚠️ Notice: This information collection may be referencing outdated material.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 National Survey of Psychiatrists Cognitive Testing	Form and Instructi
1 Questionnaire NSP-1_111418_D20.pdf	Form and Instruction
2 Alternative Full page Coversheet w/ Questionnaire (begin NSP-1_110618_v2.pdf	Form and Instruction
3 Alternative Cover Image 1 cover2.pdf	Form and Instruction
4 Alternative Cover Image 2 cover3.pdf	Form and Instruction
Screener_NSP Questionnaire redesign.docx Screener	IC Document
Consent forms for Demographic Surveys_NSP.doc Consent Form	IC Document
NSP Cognitive Interviewing Protocol_Updated 11.16.18.docx Protocol	IC Document
OMB letter - NSP cognitive interviewing_Updated 11.16.18.docx OMB Memo	IC Document

IC Title:

National Survey of Psychiatrists 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	1	Questionnaire	NSP-1_111418_D20.pdf	No	Fillable Fileable
Form and Instruction	2	Alternative Full page Coversheet w/ Questionnaire (beginning)	NSP-1_110618_v2.pdf	No	Fillable Fileable
Form and Instruction	3	Alternative Cover Image 1	cover2.pdf	No	Fillable Fileable
Form and Instruction	4	Alternative Cover Image 2	cover3.pdf	No	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

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	30	30
Annual IC Time Burden (Hours)	36	36
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Screener	Screener_NSP Questionnaire redesign.docx	11/16/2018
Consent Form	Consent forms for Demographic Surveys_NSP.doc	11/16/2018
Protocol	NSP Cognitive Interviewing Protocol_Updated 11.16.18.docx	11/16/2018
OMB Memo	OMB letter - NSP cognitive interviewing_Updated 11.16.18.docx	11/16/2018

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