Information Collection

Pilot

IC 251738 under ICR 202204-0607-001 · OMB 0607-1020.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-1020 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Pilot	Form and Instruction
1 DoD Baseline Questionnaire 17_DoD Baseline Questionnaire.docx	Form and Instruction
1 DoD Baseline Questionnaire 17_DoD Baseline Questionnaire.docx	Form and Instruction
2 English Baseline Questionnaire 27_Baseline Questionnaire_ENG.docx	Form and Instruction
2 English Baseline Questionnaire 27_Baseline Questionnaire_ENG.docx	Form and Instruction
3 English Screener Questionnaire 26_Screener Questionnaire_ENG.docx	Form and Instruction
3 English Screener Questionnaire 26_Screener Questionnaire_ENG.docx	Form and Instruction
4 Spanish Baseline and Screener Questionnaire 26_Screener and Baseline_SPA.xlsx	Form and Instruction
4 Spanish Baseline and Screener Questionnaire 26_Screener and Baseline_SPA.xlsx	Form and Instruction
5 Topical Survey DoD Ask US Topical Survey_Final.docx	Form and Instruction
5 Topical Survey DoD Ask US Topical Survey_Final.docx	Form and Instruction
6 Topicals Pilot 2030 CBAMS_pilot_FINAL_03302022.docx	Form and Instruction
6 Topicals Pilot 2030 CBAMS_pilot_FINAL_03302022.docx	Form and Instruction

IC Title:

Pilot

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	1	DoD Baseline Questionnaire	17_DoD Baseline Questionnaire.docx	No	Fillable Fileable
Form and Instruction	2	English Baseline Questionnaire	27_Baseline Questionnaire_ENG.docx	No	Fillable Fileable
Form and Instruction	3	English Screener Questionnaire	26_Screener Questionnaire_ENG.docx	No	Fillable Fileable
Form and Instruction	4	Spanish Baseline and Screener Questionnaire	26_Screener and Baseline_SPA.xlsx	No	Fillable Fileable
Form and Instruction	5	Topical Survey	DoD Ask US Topical Survey_Final.docx	No	Fillable Fileable
Form and Instruction	6	Topicals Pilot	2030 CBAMS_pilot_FINAL_03302022.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: 1,682

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	Previously Approved
Annual Number of Responses for this IC	3,364	-36	3,400
Annual IC Time Burden (Hours)	1,131	0	1,131
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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