NYCHVS Cognitive 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⚠️ Notice: This information collection may be referencing outdated material.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 NYCHVS Cognitive Interviews Form and Instructi
1 Protocol V1 (Owner) Enclosure 1_Owner Protocol_revised.docx Form and Instruction
2 Protocol V2 (Renter) Enclosure 2_Renter Protocol_revised.docx Form and Instruction
3 Flash Cards Enclosure 4_Flash Cards.docx Form and Instruction
OMB Memo_NYCHVS 2021 Redesign 190604.docx OMB Memo IC Document
Enclosure 3_Screener.docx Recruitment Screener IC Document
Enclosure 5_Consent Form.docx Consent Form IC Document
Enclosure 6_Payment Voucher.doc Voucher Form IC Document

Information Collection (IC) Details

IC Title:	NYCHVS Cognitive 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	Available Electronically?	Electronic Capability
Form and Instruction	1	Protocol V1 (Owner)	Enclosure 1_Owner Protocol_revised.docx	No	Fillable Fileable
Form and Instruction	2	Protocol V2 (Renter)	Enclosure 2_Renter Protocol_revised.docx	No	Fillable Fileable
Form and Instruction	3	Flash Cards	Enclosure 4_Flash Cards.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: 72	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	72	72
Annual IC Time Burden (Hours)	108	108
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo	OMB Memo_NYCHVS 2021 Redesign 190604.docx	06/05/2019
Recruitment Screener	Enclosure 3_Screener.docx	06/05/2019
Consent Form	Enclosure 5_Consent Form.docx	06/05/2019
Voucher Form	Enclosure 6_Payment Voucher.doc	06/05/2019

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