Information Collection

Survey Pretests

IC 229814 under ICR 202312-0920-008 · OMB 0920-0621.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0621 Survey Pretests	Form and Instruction
0920-0621 Cognitive Interview Item Form 0621 NYTS Att N5 Cognitive Interview Items_final.docx	Form and Instruction
0920-0621 Cognitive Interview Item Form 0621_NYTS_Att_N5_Cognitive Interview Items_20240520_clean_.docx	Form and Instruction

IC Title:

Survey Pretests

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
Form and Instruction	0920-0621	Cognitive Interview Item Form	0621_NYTS_Att_N5_Cognitive Interview Items_20240520_clean_.docx	N/A	No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

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	100	70	30
Annual IC Time Burden (Hours)	75	52	23
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.