Successful Worker Sample Web-based Experiment

National Beneficiary Survey (Round 8)

Documents and Forms

Document Name Document Type
Attachment B - Web-Based NBS Instrument for Experiment.pdf Other-Web-Based NBS
Attachment B - Web-Based NBS Instrument for Experiment.pdf Other-Web-Based NBS
Attachment A - NBS Round 8 Instrument.pdf Other-Representative Beneficiary and
Attachment A - NBS Round 8 Instrument.pdf Other-Representative Beneficiary and
Attachment D - Respondent Correspondence.pdf Other-Respondnet Coorespondence
Attachment D - Respondent Correspondence.pdf Other-Respondnet Coorespondence
Attachment E - Confidentiality Pledge.pdf Other-Confidentiality Pledge
Attachment E - Confidentiality Pledge.pdf Other-Confidentiality Pledge

Information Collection (IC) Details

IC Title:	Successful Worker Sample Web-based Experiment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Web-Based NBS	Attachment B - Web-Based NBS Instrument for Experiment.pdf	Yes	Yes	Fillable Fileable
Other-Representative Beneficiary and Successful Worker Combined Questionnaire	Attachment A - NBS Round 8 Instrument.pdf	No		Paper Only
Other-Respondnet Coorespondence	Attachment D - Respondent Correspondence.pdf	No		Printable Only
Other-Confidentiality Pledge	Attachment E - Confidentiality Pledge.pdf	No		Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 125	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	125	125
Annual IC Time Burden (Hours)	52	52
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.