Information Collection

ORS Cognitive Testing

IC 227391 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⚠️ Notice: This information collection may be referencing outdated material.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 Attachments ORS Cognitive Testing	Form and Instruction
Attachments Survey Protocol Survey Protocol.docx	Form and Instruction
Attachment D Online Protocol Attachment D - ORS Online Protocol for Cognitive Testing Summer 2017.pdf	Form and Instruction
Note to Reviewer - ORS Cog Questions.docx Note to Reviewer - ORS Cognitive Questions	IC Document

IC Title:

ORS Cognitive Testing

Agency IC Tracking Number:

21717

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	Attachments	Survey Protocol	Survey Protocol.docx		Yes	Yes	Fillable Printable
Form and Instruction	Attachment D	Online Protocol	Attachment D - ORS Online Protocol for Cognitive Testing Summer 2017.pdf		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 45

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 67 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	45	45
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Note to Reviewer - ORS Cognitive Questions	Note to Reviewer - ORS Cog Questions.docx	07/12/2017

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