CEDSCI Cognitive Testing Addendum 4

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⚠️ Notice: This information collection may be referencing outdated material.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 CEDSCI Cognitive Testing Addendum 4 Form and Instruction
1 Protocol Enclosure 2 revised protocol.docx Form and Instruction
Addendum to request burden hours.docx OMB Memo IC Document
Enclosure 1 original OMB letter.docx Original OMB Package Memo IC Document
Enclosure 3 original demographic questionnaire.docx Demographic Questionnaire IC Document
Enclosure 4 modified internet experience questionnaire.docx Internet Experience Questionnaire IC Document
Enclosure 5 modified debriefing questionnaire.docx Debriefing Questionnaire IC Document
Enclosure 6 modified satisfaction questionnaire.docx Satisfaction Questionnaire IC Document
Addendum to request burden hours-clean .docx Addendum to request burden hours-clean IC Document

Information Collection (IC) Details

IC Title:	CEDSCI Cognitive Testing Addendum 4	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	Enclosure 2 revised 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: 120	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	120	120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo	Addendum to request burden hours.docx	10/05/2020
Original OMB Package Memo	Enclosure 1 original OMB letter.docx	10/05/2020
Demographic Questionnaire	Enclosure 3 original demographic questionnaire.docx	10/05/2020
Internet Experience Questionnaire	Enclosure 4 modified internet experience questionnaire.docx	10/05/2020
Debriefing Questionnaire	Enclosure 5 modified debriefing questionnaire.docx	10/05/2020
Satisfaction Questionnaire	Enclosure 6 modified satisfaction questionnaire.docx	10/05/2020
Addendum to request burden hours-clean	Addendum to request burden hours-clean .docx	01/04/2021

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