Information Collection

[NCZEID] DCIPHER External User Satisfaction Survey

IC 265167 under ICR 202402-0920-010 · OMB 0920-1071.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1071 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-24CX [NCZEID] DCIPHER External User Satisfaction Survey	Form and Instruction
0920-24CX Eligibility Screener Attachment 1 - Eligibility Screener.docx	Form and Instruction
0920-24CX Eligible Participant Screener Attachment 3 - Eligible Participant Screener_FG.docx	Form and Instruction
0920-24CX Focus Group Moderator Guide Attachment 8 - Focus Group Moderator Guide .docx	Form and Instruction
Attachment 2 - Recruitment Materials_FG.docx Attachment 2 - Recruitment Materials_FG	IC Document
Attachment 4 - Privacy Agreement.docx Attachment 4 - Privacy Agreement	IC Document
Attachment 5 - Respondent Consent Form_FG.docx Attachment 5 - Respondent Consent Form	IC Document
Attachment 7 - Participant Confirmation Email_FG.docx Attachment 7 - Participant Confirmation Email_FG	IC Document
Attachment 6 - Standard Invitation_FG .docx Attachment 6 - Standard Invitation_FG	IC Document
Attachment 9 - Messages to be tested HABs.docx Attachment 9 - Messages to be tested HABs	IC Document
Attachment 10- Human Subjects Determination.pdf Attachment 10- Human Subjects Determination	IC Document
GenIC Request HAB Communication Evaluation.docx GenIC Request HAB Communication Evaluation	IC Document
Supporting Statement A.docx SSA	IC Document
Supporting Statement B.docx Supporting Statement B	IC Document

IC Title:

[NCZEID] DCIPHER External User Satisfaction Survey

Agency IC Tracking Number:

0920-24CZ

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-24CX	Eligibility Screener	Attachment 1 - Eligibility Screener.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-24CX	Eligible Participant Screener	Attachment 3 - Eligible Participant Screener_FG.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-24CX	Focus Group Moderator Guide	Attachment 8 - Focus Group Moderator Guide .docx	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 532

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	532	532
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 2 - Recruitment Materials_FG	Attachment 2 - Recruitment Materials_FG.docx	02/13/2024
Attachment 4 - Privacy Agreement	Attachment 4 - Privacy Agreement.docx	02/13/2024
Attachment 5 - Respondent Consent Form	Attachment 5 - Respondent Consent Form_FG.docx	02/13/2024
Attachment 7 - Participant Confirmation Email_FG	Attachment 7 - Participant Confirmation Email_FG.docx	02/13/2024
Attachment 6 - Standard Invitation_FG	Attachment 6 - Standard Invitation_FG .docx	02/13/2024
Attachment 9 - Messages to be tested HABs	Attachment 9 - Messages to be tested HABs.docx	02/13/2024
Attachment 10- Human Subjects Determination	Attachment 10- Human Subjects Determination.pdf	02/13/2024
GenIC Request HAB Communication Evaluation	GenIC Request HAB Communication Evaluation.docx	02/13/2024
SSA	Supporting Statement A.docx	02/13/2024
Supporting Statement B	Supporting Statement B.docx	02/13/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.