Information Collection

Additional Cognitive Testing for 2021 Household Survey

IC 244318 under ICR 201912-3064-002 · OMB 3064-0198.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3064-0198 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2021 Household Sur Additional Cognitive Testing for 2021 Household Survey	Form and Instruction
2021 Household Sur 2021 Unbanked Underbanked Household Survey Cognitive Tes hhsurvey_2021instrument_2020-10-30.docx	Form and Instruction
Justification MM 0198 - Additional Cognitive Testing 2021 HH Survey.docx Justification Memo - Additional Cognitive Testing 2021 HH Survey	IC Document

IC Title:

Additional Cognitive Testing for 2021 Household Survey

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	2021 Household Survey Cognitive	2021 Unbanked Underbanked Household Survey Cognitive Testing	hhsurvey_2021instrument_2020-10-30.docx		No		Paper Only

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15

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	15	15
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification Memo - Additional Cognitive Testing 2021 HH Survey	Justification MM 0198 - Additional Cognitive Testing 2021 HH Survey.docx	10/30/2020

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