Information Collection

Cognitive Testing for the Survey of Respirator Use and Practices

IC 248259 under ICR 202009-1220-006 · OMB 1220-0141.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1220-0141 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachments 1-3 Cognitive Testing for the Survey of Respirator Use and Practices	Form and Instruction
Attachments 1-3 Survey Protocol - SRUP Phase 2 Cognitive Testing Attachments 1- 3 Survey Protocol - Final.docx	Form and Instruction
Note to Reviewer - Survey of Respirator Use - Round 2 Cognitive Interviews May_21_Final.docx Note to Reviewer - Cognitive Testing for the Survey of Respirator Use and Practices	IC Document

IC Title:

Cognitive Testing for the Survey of Respirator Use and Practices

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	Attachments 1-3	Survey Protocol - SRUP Phase 2 Cognitive Testing	Attachments 1- 3 Survey Protocol - Final.docx		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	20	20
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Note to Reviewer - Cognitive Testing for the Survey of Respirator Use and Practices	Note to Reviewer - Survey of Respirator Use - Round 2 Cognitive Interviews May_21_Final.docx	07/07/2021

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