Cognitive and Usability Evaluation of PHMSA 5800 Form

Generic Clearance for Questionnaire Pretesting Research

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.