Information Collection

CEDSCI Usability Evaluation Addendum

IC 235998 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⚠️ Notice: This information collection may be referencing outdated material.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 CEDSCI Usability Evaluation Addendum	Form
1 Demographics Questionnaire Enclosure 3 original demographic questionnaire.docx	Form
2 Internet Use Questionnaire Enclosure 8 modified internet experience questionnaire.docx	Form
3 Debriefing Questionnaire Enclosure 9 modified debriefing questionnaire.docx	Form
4 Satisfaction Questionnaire Enclosure 10 modified satisfaction questionnaire.docx	Form
Addendum to request burden hour.docx OMB Memo	IC Document
Enclosure 1 original OMB letter.docx Original OMB Submission Memo	IC Document
Enclosure 2 original sample testing protocol.docx Protocol	IC Document
Enclosure 4 original internet experience questionnaire.docx Original OMB Submission Internet Use Questionnaire	IC Document
Enclosure 5 original satisfaction questionnaire.docx Original OMB Submission Satisfaction Questionnaire	IC Document
Enclosure 6 addendum to add in census refresh.docx First Addendum OMB Memo	IC Document
Enclosure 7 modified study plan.docx First Addendum Study Plan Modifications	IC Document

IC Title:

CEDSCI Usability Evaluation Addendum

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	1	Demographics Questionnaire	Enclosure 3 original demographic questionnaire.docx	No	Fillable Fileable
Form	2	Internet Use Questionnaire	Enclosure 8 modified internet experience questionnaire.docx	No	Fillable Fileable
Form	3	Debriefing Questionnaire	Enclosure 9 modified debriefing questionnaire.docx	No	Fillable Fileable
Form	4	Satisfaction Questionnaire	Enclosure 10 modified satisfaction questionnaire.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: 63

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	63	63
Annual IC Time Burden (Hours)	63	63
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Memo	Addendum to request burden hour.docx	05/08/2019
Original OMB Submission Memo	Enclosure 1 original OMB letter.docx	05/08/2019
Protocol	Enclosure 2 original sample testing protocol.docx	05/08/2019
Original OMB Submission Internet Use Questionnaire	Enclosure 4 original internet experience questionnaire.docx	05/08/2019
Original OMB Submission Satisfaction Questionnaire	Enclosure 5 original satisfaction questionnaire.docx	05/08/2019
First Addendum OMB Memo	Enclosure 6 addendum to add in census refresh.docx	05/08/2019
First Addendum Study Plan Modifications	Enclosure 7 modified study plan.docx	05/08/2019

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