Information Collection

Survey (icl. informed consent and pre-collection questions)

IC 265150 under ICR 202311-0960-002 · OMB 0960-0836.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0836 can be found here:

2024-12-05 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A-20. Pre-collection instrument.pdf	Other- Pre-collection instrument
Attachment A-20. Pre-collection instrument.pdf	Other- Pre-collection instrument
Attachment A-8 Exiter and Possible Exiter Survey.pdf	Other-Beyond Benefits Study (BBS Sur
Attachment A-8. Exiter and Possible Exiter Survey (FINAL).docx	Other-Beyond Benefits Study (BBS Sur
Attachment A-9. Exiter and Possible Exiter IDI Letter and Consent.pdf	Other-Exiter and Possible Exiter IDI
Attachment A-9. Exiter and Possible Exiter IDI Letter and Consent.pdf	Other-Exiter and Possible Exiter IDI
Attachment A-11. Exiter and Possible Exiter Focus Group Letter and Consent.pdf	Other-Exiter and Possible Exiter Foc
Attachment A-11. Exiter and Possible Exiter Focus Group Letter and Consent.pdf	Other-Exiter and Possible Exiter Foc
Attachment A-13. Service Provider Focus Group Letter and Consent.pdf	Other- Service Provider Focus Group
Attachment A-13. Service Provider Focus Group Letter and Consent.pdf	Other- Service Provider Focus Group
Attachment A-14. State Agency Leadership IDI Letter and Consent.pdf	Other-State Agency Leadership IDI Le
Attachment A-14. State Agency Leadership IDI Letter and Consent.pdf	Other-State Agency Leadership IDI Le
Attachment A-15. MI Practitioner Focus Group Consent.pdf	Other- MI Practitioner Focus Group C
Attachment A-15. MI Practitioner Focus Group Consent.pdf	Other- MI Practitioner Focus Group C
Attachment A-16. Exiter and Possible Exiter Survey Letter and Consent.pdf	Other- Exiter and Possible Exiter Su
Attachment A-16. Exiter and Possible Exiter Survey Letter and Consent.pdf	Other- Exiter and Possible Exiter Su

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Survey (icl. informed consent and pre-collection questions)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other- Pre-collection instrument	Attachment A-20. Pre-collection instrument.pdf	No	Paper Only
Other-Beyond Benefits Study (BBS Survey)	Attachment A-8. Exiter and Possible Exiter Survey (FINAL).docx	No	Paper Only
Other-Exiter and Possible Exiter IDI Letter and Consent	Attachment A-9. Exiter and Possible Exiter IDI Letter and Consent.pdf	No	Paper Only
Other-Exiter and Possible Exiter Focus Group Letter and Consent	Attachment A-11. Exiter and Possible Exiter Focus Group Letter and Consent.pdf	No	Paper Only
Other- Service Provider Focus Group Letter and Consent	Attachment A-13. Service Provider Focus Group Letter and Consent.pdf	No	Paper Only
Other-State Agency Leadership IDI Letter and Consent.	Attachment A-14. State Agency Leadership IDI Letter and Consent.pdf	No	Paper Only
Other- MI Practitioner Focus Group Consent.	Attachment A-15. MI Practitioner Focus Group Consent.pdf	No	Paper Only
Other- Exiter and Possible Exiter Survey Letter and Consent	Attachment A-16. Exiter and Possible Exiter Survey Letter and Consent.pdf	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,000

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
Annual Number of Responses for this IC	4,000	4,000
Annual IC Time Burden (Hours)	3,333	3,333
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.