CEDSCI Usability Evaluation Addendum

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⚠️ Notice: This information collection may be referencing outdated material.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

Information Collection (IC) Details

IC Title:	CEDSCI Usability Evaluation Addendum	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	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 %

	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

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.