2019 SAS Telemedicine Cog Interviews

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⚠️ Notice: This information collection may be referencing outdated material.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 SAS Telemedicine Cog Interviews Form
1 Attachment A - Proposed Telemedicine Questions for SAS Attachment A - Proposed Telemedicine Questions for the Services Annual Survey.docx Form
2 Attachment C - SAS Questionnaire Attachment C - Services Annual Survey.docx Form
Telemedicine OMB Letter.docx OMB Memo IC Document
Attachment B - Telemedicine Cognitive Interview Protocol.docx Attachment B - Cognitive Protocol IC Document
Attachment D - Recruiting Script.docx Attachment D - Recruiting Scripts IC Document

Information Collection (IC) Details

IC Title:	2019 SAS Telemedicine Cog Interviews	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	1	Attachment A - Proposed Telemedicine Questions for SAS	Attachment A - Proposed Telemedicine Questions for the Services Annual Survey.docx		No		Fillable Fileable
Form	2	Attachment C - SAS Questionnaire	Attachment C - Services Annual Survey.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: 50	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo	Telemedicine OMB Letter.docx	12/06/2018
Attachment B - Cognitive Protocol	Attachment B - Telemedicine Cognitive Interview Protocol.docx	12/06/2018
Attachment D - Recruiting Scripts	Attachment D - Recruiting Script.docx	12/06/2018

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