Information Collection

2019 VIUS Cognitive Testing

IC 237987 under ICR 201812-0607-001 · OMB 0607-0978.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0978 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 2019 VIUS Cognitive Testing	Form and Instruction
1 9501 VIUS Worksheet Attachment C - 9501 VIUS Worksheet.docx	Form and Instruction
2 9502 VIUS Worksheet Attachment D - 9502 VIUS Worksheet.docx	Form and Instruction
OMB Request - 2019 VIUS Cognitive Interviewing UPDATED.docx OMB Memo	IC Document
Attachment A - Protocol 9501 Light Truck.docx Protocol for 9501 VIUS Worksheet	IC Document
Attachment B - Protocol 9502 Tractor Trailer.docx Protocol for 9502 VIUS Worksheet	IC Document
Attachment E - Classified Website Advertisement.docx Recruiting Ad	IC Document
Attachment F - Consent form with letterhead (2).pdf Consent Form	IC Document

IC Title:

2019 VIUS Cognitive Testing

Agency IC Tracking Number:

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	1	9501 VIUS Worksheet	Attachment C - 9501 VIUS Worksheet.docx		No		Fillable Fileable
Form and Instruction	2	9502 VIUS Worksheet	Attachment D - 9502 VIUS Worksheet.docx		No		Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 90

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	90	90
Annual IC Time Burden (Hours)	113	113
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Memo	OMB Request - 2019 VIUS Cognitive Interviewing UPDATED.docx	12/12/2019
Protocol for 9501 VIUS Worksheet	Attachment A - Protocol 9501 Light Truck.docx	10/03/2019
Protocol for 9502 VIUS Worksheet	Attachment B - Protocol 9502 Tractor Trailer.docx	10/03/2019
Recruiting Ad	Attachment E - Classified Website Advertisement.docx	10/03/2019
Consent Form	Attachment F - Consent form with letterhead (2).pdf	10/03/2019

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