Information Collection

Cognitive and Usability Evaluation of PHMSA 5800 Form

IC 239263 under ICR 201909-0607-002 · OMB 0607-0725.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0725 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PHMSA OMB draft letter_192020.docx OMB Memo	IC Document
Attachment B1_Consent form_Usability and eyetracking.docx Usability Consent Form	IC Document
Attachment B2_Consent form_Cognitive testing.docx Cognitive Consent Form	IC Document
Attachment C_PHMSA_Testing Protocol_1920.docx Protocol	IC Document
Attachment D_Demographic Questionnaire.docx Demographic Questionnaire	IC Document
Attachment E_Computer use and Internet Experience questionnaire.docx Computer Use Questionnaire	IC Document
Attachment F_Satisfaction questionnaire.docx Satisfaction Questionnaire	IC Document

IC Title:

Cognitive and Usability Evaluation of PHMSA 5800 Form

Agency IC Tracking Number:

IC Status: Pending

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

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector:

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	50	50
Annual IC Time Burden (Hours)	63	63
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Memo	PHMSA OMB draft letter_192020.docx	01/14/2020
Usability Consent Form	Attachment B1_Consent form_Usability and eyetracking.docx	01/14/2020
Cognitive Consent Form	Attachment B2_Consent form_Cognitive testing.docx	01/14/2020
Protocol	Attachment C_PHMSA_Testing Protocol_1920.docx	01/14/2020
Demographic Questionnaire	Attachment D_Demographic Questionnaire.docx	01/14/2020
Computer Use Questionnaire	Attachment E_Computer use and Internet Experience questionnaire.docx	01/14/2020
Satisfaction Questionnaire	Attachment F_Satisfaction questionnaire.docx	01/14/2020

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