Information Collection

ORS Cognitive Item Test - Multi Mode

IC 223152 under ICR 201608-1220-001 · OMB 1220-0141.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1220-0141 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Appendices A-F ORS Cognitive Item Test - Multi Mode	Form and Instruction
Appendices A-F Interview Protocol Appendices A-F - Interview Protocol.docx	Form and Instruction
ORS_Cog_items_multi-method_final_9-7-16.docx Note to Reviewer - ORS Cognitive Items Multi Mode Test	IC Document

IC Title:

ORS Cognitive Item Test - Multi Mode

Agency IC Tracking Number:

21621

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Appendices A-F	Interview Protocol	Appendices A-F - Interview Protocol.docx		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 676

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 94 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	676	676
Annual IC Time Burden (Hours)	133	133
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Note to Reviewer - ORS Cognitive Items Multi Mode Test	ORS_Cog_items_multi-method_final_9-7-16.docx	09/07/2016

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