Information Collection

MEPS – IC Cognitive Testing

IC 240641 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⚠️ Notice: This information collection may be referencing outdated material.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
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

IC Title:

MEPS â IC 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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.