Vaccine Question Pretesting Survey for Household Pulse Survey

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⚠️ Notice: This information collection may be referencing outdated material.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 Vaccine Question Pretesting Survey for Household Pulse Survey Form and Instruction
1 Vaccine Questionnaire Enclosure1_VaccineQuestionnaire.docx Form and Instruction
Vaccine Questions Cog Testing OMB Memo.docx OMB memo IC Document
Enclosure2_InvitationEmails.docx Invitation Emails IC Document

Information Collection (IC) Details

IC Title:	Vaccine Question Pretesting Survey for Household Pulse Survey	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	Vaccine Questionnaire	Enclosure1_VaccineQuestionnaire.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: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	263	263
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB memo	Vaccine Questions Cog Testing OMB Memo.docx	12/11/2020
Invitation Emails	Enclosure2_InvitationEmails.docx	12/11/2020

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