Information Collection

Copy Testing Surveys

IC 245352 under ICR 202104-0990-004 · OMB 0990-0476.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0476 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Part A - Attachment H_COVID-19 Copy Testing Survey_Consent Form.docx	Other-CTS-Part A, Attachment H
Part A - Attachment I_COVID-19 Copy Testing Survey_Communications.docx	Other-CTS-Part A, Attachment I
Part A - Attachment J_COVID-19 Copy Testing Survey External IRB Determination.pdf	Other-CTS-Part A, Attachment J
Part B - Attachment C_COVID-19 Copy Testing Survey_Questionnaire.docx	Other-CTS-Part B, Attachment C
0990-0476 HHS COVID-19 Brand Testing Questionnaire FINAL.docx	Other-Change questionnaire
0990-0476 HHS COVID-19 Testing Collages_FINAL_020821.pdf Covid-19 Testing Collage	IC Document

IC Title:

Copy Testing Surveys

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-CTS-Part A, Attachment H	Part A - Attachment H_COVID-19 Copy Testing Survey_Consent Form.docx	Yes	Yes	Fillable Fileable
Other-CTS-Part A, Attachment I	Part A - Attachment I_COVID-19 Copy Testing Survey_Communications.docx	Yes	Yes	Fillable Fileable
Other-CTS-Part A, Attachment J	Part A - Attachment J_COVID-19 Copy Testing Survey External IRB Determination.pdf	Yes	Yes	Fillable Fileable
Other-CTS-Part B, Attachment C	Part B - Attachment C_COVID-19 Copy Testing Survey_Questionnaire.docx	Yes	Yes	Fillable Fileable
Other-Change questionnaire	0990-0476 HHS COVID-19 Brand Testing Questionnaire FINAL.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 53,600

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	Previously Approved
Annual Number of Responses for this IC	53,600	53,600
Annual IC Time Burden (Hours)	4,248	4,248
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Covid-19 Testing Collage	0990-0476 HHS COVID-19 Testing Collages_FINAL_020821.pdf	02/08/2021

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