Information Collection

Pilot

IC 251738 under ICR 202205-0607-003 · OMB 0607-1020.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Pilot	Form and Instruction
Form 1 DoD Baseline Questionnaire Pilot	Form and Instruction
Form 2 English Baseline Questionnaire Pilot	Form and Instruction
Form 3 English Screener Questionnaire Pilot	Form and Instruction
Form 4 Spanish Baseline and Screener Questionnaire Pilot	Form and Instruction
Form 5 Topical Survey Pilot	Form and Instruction
Form 6 Topicals Pilot 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: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Electronic Capability
Form and Instruction	1	No	Fillable Fileable
Form and Instruction	2	No	Fillable Fileable
Form and Instruction	3	No	Fillable Fileable
Form and Instruction	4	No	Fillable Fileable
Form and Instruction	5	No	Fillable Fileable
Form and Instruction	6	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	Previously Approved
Annual Number of Responses for this IC	3,364	3,364
Annual IC Time Burden (Hours)	1,131	1,131
Annual IC Cost Burden (Dollars)	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.

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