Information Collection

ATUS Web Diary Pilot Test

IC 263809 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⚠️ Notice: This information collection may be referencing outdated material.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 Attachment C Debriefing Interview Eligibility and Scheduling Screener ATUS Web Diary Pilot Test	Form and Instruction
Form Attachment E Debriefing Interview Protocol ATUS Web Diary Pilot Test	Form and Instruction
Form Attachment F Web Diary (Screenshots) ATUS Web Diary Pilot Test	Form and Instruction
Form Attachment G Question Before and After Web Diary ATUS Web Diary Pilot Test	Form
Form Attachment D Debriefing Interview Consent ATUS Web Diary Pilot Test	Form and Instruction
Form Attachment B Pilot Test Consent ATUS Web Diary Pilot Test	Form and Instruction
Attachment C Debriefing Interview Eligibility and Scheduling Screener Attachment C - Debriefing Interview Eligibility Screener.docx	Form and Instruction
Attachment E Debriefing Interview Protocol Attachment E - Debriefing Interview Protocol.docx	Form and Instruction
Attachment F Web Diary (Screenshots) Attachment F - Web Diary Screenshots.docx	Form and Instruction
Attachment G Question Before and After Web Diary Attachment G - Questions Displayed Before and After Web Diary.docx	Form
Attachment D Debriefing Interview Consent Attachment D - Debriefing Interview Consent Statement.docx	Form and Instruction
Attachment B Pilot Test Consent Attachment B - Pilot Test Consent Statement_Final.docx	Form and Instruction
Note to Reviewer - ATUS Web Diary Pilot Test.docx Note to Reviewer - ATUS Web Diary Pilot Test	IC Document
Attachment A - Pilot Test Recruitment Materials.docx Attachment A	IC Document

IC Title:

ATUS Web Diary Pilot Test

Agency IC Tracking Number:

22401

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Attachment C	No		Printable Only
Form and Instruction	Attachment E	No		Printable Only
Form and Instruction	Attachment F	Yes	Yes	Fillable Fileable
Form	Attachment G	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment D	Yes	No	Printable Only
Form and Instruction	Attachment B	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,540

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,540	2,540
Annual IC Time Burden (Hours)	518	518
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Note to Reviewer - ATUS Web Diary Pilot Test		12/06/2023
Attachment A		12/06/2023

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

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