Information Collection

Usability Testing of CE Electronic Diary

IC 220548 under ICR 201706-1220-008 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Appendix B Usability Testing of CE Electronic Diary	Form and Instruction
Appendix B Interview Protocol Appendix B - Interview Protocol.docx	Form and Instruction
Appendix C Screenshots of Electronic Diary Appendix C - Screenshots of Electronic Diary.docx	Form
Appendix E Consent Form Appendix E - Consent Form.docx	Form and Instruction
Note to Reviewer - CE Electronic Diary Test (14Mar16).docx Note to Reviewer - CE Electronic Diary Test	IC Document

IC Title:

Usability Testing of CE Electronic Diary

Agency IC Tracking Number:

21608

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Appendix B	Interview Protocol	Appendix B - Interview Protocol.docx	Yes	No	Printable Only
Form	Appendix C	Screenshots of Electronic Diary	Appendix C - Screenshots of Electronic Diary.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix E	Consent Form	Appendix E - Consent Form.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: 40

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Note to Reviewer - CE Electronic Diary Test	Note to Reviewer - CE Electronic Diary Test (14Mar16).docx	03/14/2016

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