Information Collection

Cognitive Testing

IC 214643 under ICR 202312-0920-008 · OMB 0920-0621.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
OMB info for Cognitive Testing.docx	Other-OMB Header and Burden Statemen
OMB info for Cognitive Testing.docx	Other-OMB Header and Burden Statemen

IC Title:

Cognitive Testing

Agency IC Tracking Number:

0920-0621

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-OMB Header and Burden Statement			OMB info for Cognitive Testing.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

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	60	20	40
Annual IC Time Burden (Hours)	120	40	80
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.