Cognitive Testing for COVID-19 Questions on the MEPS – IC

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⚠️ Notice: This information collection may be referencing outdated material.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 Cognitive Testing for COVID-19 Questions on the MEPS – IC Form and Instruction
1 Protocol MEPS_IC_COVID19 _Attachment A_protocol.docx Form and Instruction
MEPS_IC_COVID19 _OMB letter.docx OMB Memo IC Document
_MEPS_IC_COVID19_Attachment B_PIA content.docx Consent Form IC Document
MEPS_IC_COVID19 _Attachment A_protocol 10292020.docx MEPS_IC_COVID19 _Attachment A_protocol 10292020 IC Document
MEPS_IC_COVID19 _OMB letter- 10262020.docx MEPS_IC_COVID19 _OMB letter- 10262020 IC Document

Information Collection (IC) Details

IC Title:	Cognitive Testing for COVID-19 Questions on the MEPS – IC	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	MEPS_IC_COVID19 _Attachment A_protocol.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: 50	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	50	50
Annual IC Time Burden (Hours)	29	29
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo	MEPS_IC_COVID19 _OMB letter.docx	09/14/2020
Consent Form	_MEPS_IC_COVID19_Attachment B_PIA content.docx	09/14/2020
MEPS_IC_COVID19 _Attachment A_protocol 10292020	MEPS_IC_COVID19 _Attachment A_protocol 10292020.docx	10/29/2020
MEPS_IC_COVID19 _OMB letter- 10262020	MEPS_IC_COVID19 _OMB letter- 10262020.docx	10/29/2020

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