Information Collection

CEDSCI Cognitive Testing Addendum 4

IC 243878 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⚠️ Notice: This information collection may be referencing outdated material.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 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

IC Title:

CEDSCI Cognitive Testing Addendum 4

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.