Information Collection

Att I1_Computer Survey (Screenshots)

IC 225941 under ICR 201702-0920-016 · OMB 0920-1205.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1205 can be found here:

Documents and Forms

Document Name Document Type
Att I1 - Computer Survey Screenshot Example 1 .jpg Other-WORD
Att I1A - Computer Survey Screenshot Example 1 .jpg Att I1A_ 2017 NYTS Computer Based Pilot (screenshots) IC Document
Att I1B - Computer Survey Screenshot Example 2 .jpg Att I1B_NYTS Computer Based Pilot (sceenshots) IC Document
Att I2 & I3_Parental Permission Form Distribution Script .docx Att I2 & 3_Parental Permission Packet IC Document
Att I4_Parental Permission Form and Fact Sheet (Spanish Version).docx Att I3_Parental Permission Packet (Spanish) IC Document
Att I5_Parental Permission Form Reminder Notice (English Version).docx Att I5_Parental Reminder Notice IC Document
Att I6_Parental Permission Form Reminder Notice (Spanish Version).docx Att I6_Parental Reminder Notice (Spanish) IC Document
Att I7_NYTS QA Script.docx Att I7_Q&A IC Document
Att I8_Example Instrument Testing Activity - 11 09 16.docx Att I8 Example Instrument Testing Activity IC Document
Att I9_Example Testing Activity.docx Att I9 Example Testing Activity IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Att I1_Computer Survey (Screenshots)	Agency IC Tracking Number:	16AWN

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Att I1 - Computer Survey Screenshot Example 1 .jpg		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,100	6,100
Annual IC Time Burden (Hours)	3,558	3,558
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att I1A_ 2017 NYTS Computer Based Pilot (screenshots)	Att I1A - Computer Survey Screenshot Example 1 .jpg	03/01/2017
Att I1B_NYTS Computer Based Pilot (sceenshots)	Att I1B - Computer Survey Screenshot Example 2 .jpg	03/01/2017
Att I2 & 3_Parental Permission Packet	Att I2 & I3_Parental Permission Form Distribution Script .docx	03/01/2017
Att I3_Parental Permission Packet (Spanish)	Att I4_Parental Permission Form and Fact Sheet (Spanish Version).docx	03/01/2017
Att I5_Parental Reminder Notice	Att I5_Parental Permission Form Reminder Notice (English Version).docx	03/01/2017
Att I6_Parental Reminder Notice (Spanish)	Att I6_Parental Permission Form Reminder Notice (Spanish Version).docx	03/01/2017
Att I7_Q&A	Att I7_NYTS QA Script.docx	03/01/2017
Att I8 Example Instrument Testing Activity	Att I8_Example Instrument Testing Activity - 11 09 16.docx	03/01/2017
Att I9 Example Testing Activity	Att I9_Example Testing Activity.docx	03/01/2017

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