Information Collection

[NCZEID] DCIPHER External User Satisfaction Survey

IC 265167 under ICR 202403-0920-013 · 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⚠️ Notice: This information collection may be referencing outdated material.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
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 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 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
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 2 - Recruitment Materials_FG.docx Attachment 2 - Recruitment Materials_FG	IC Document
Attachment 4 - Privacy Agreement.docx Attachment 4 - Privacy Agreement	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 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 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 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 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
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
GenIC Request HAB Communication Evaluation.docx GenIC Request HAB Communication Evaluation	IC Document
Supporting Statement A.docx SSA	IC Document
Supporting Statement A.docx SSA	IC Document
Supporting Statement B.docx Supporting Statement B	IC Document
Supporting Statement B.docx Supporting Statement B	IC Document

Information Collection (IC) Details

View Information Collection (IC)

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

Federal Enterprise Architecture Business Reference Module

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.