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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.