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System Usability Scale (SUS)
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
OMB: 0935-0179
IC ID: 233778
OMB.report
HHS/AHRQ
OMB 0935-0179
ICR 202310-0935-001
IC 233778
( )
Documents and Forms
Document Name
Document Type
Form 1
System Usability Scale (SUS)
Form and Instruction
1 System Usability Scale (SUS)
Attachment H_System Usability Scale_101818.docx
Form and Instruction
1 System Usability Scale (SUS)
Attachment H_System Usability Scale_101818.docx
Form and Instruction
Fast Track Submission_System Usability Survey_101818.doc
Fast Track Supporting Statement
IC Document
Fast Track Submission_System Usability Survey_101818.doc
Fast Track Supporting Statement
IC Document
Supporting Statement_101818.doc
Total Overview
IC Document
Supporting Statement_101818.doc
Total Overview
IC Document
Cover Page SUB.doc
Cover Letter
IC Document
Cover Page SUB.doc
Cover Letter
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
System Usability Scale (SUS)
Agency IC Tracking Number:
IC Status:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
1
System Usability Scale (SUS)
Attachment H_System Usability Scale_101818.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
180
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
100 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
180
0
0
0
0
180
Annual IC Time Burden (Hours)
14
0
0
0
0
14
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Fast Track Supporting Statement
Fast Track Submission_System Usability Survey_101818.doc
10/29/2018
Total Overview
Supporting Statement_101818.doc
10/29/2018
Cover Letter
Cover Page SUB.doc
10/29/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.