MEPS – IC Cognitive Testing

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⚠️ Notice: This information collection may be referencing outdated material.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
Form 1 MEPS – IC Cognitive Testing Form and Instruction
1 Protocol Attachment A_ MEPS IC Interview Protocol.docx Form and Instruction
MEPS_IC_OMB_letter_2020_31720.docx OMB Memo IC Document
Attachment B_PIA content_31720.docx Consent Form IC Document

Information Collection (IC) Details

IC Title:	MEPS – IC Cognitive Testing	Agency IC Tracking Number:

IC Status: New

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
Form and Instruction	1	Protocol	Attachment A_ MEPS IC Interview Protocol.docx		No		Paper Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo	MEPS_IC_OMB_letter_2020_31720.docx	03/18/2020
Consent Form	Attachment B_PIA content_31720.docx	03/18/2020

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