MEPS 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⚠️ Notice: This information collection may be referencing outdated material.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 MEPS Cognitive Testing Form and Instructi
1 Form MEPS 10 meps10_021519.pdf Form and Instruction
2 Form MEPS 10s meps10s_021519.pdf Form and Instruction
3 Form MEPS 11 meps11_021519.pdf Form and Instruction
4 Form MEPS 11s meps11s_021519.pdf Form and Instruction
MEPS_IC_OMB_letter_31419.docx OMB Memo IC Document
Attachment A_MEPS Interview_Protocol.docx Protocol IC Document

Information Collection (IC) Details

IC Title:	MEPS 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	Available Electronically?	Electronic Capability
Form and Instruction	1	Form MEPS 10	meps10_021519.pdf	No	Fillable Fileable
Form and Instruction	2	Form MEPS 10s	meps10s_021519.pdf	No	Fillable Fileable
Form and Instruction	3	Form MEPS 11	meps11_021519.pdf	No	Fillable Fileable
Form and Instruction	4	Form MEPS 11s	meps11s_021519.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: 60	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo	MEPS_IC_OMB_letter_31419.docx	03/18/2019
Protocol	Attachment A_MEPS Interview_Protocol.docx	03/18/2019

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