Internet Survey (including informed consent and screener)

New Applicant Survey (NAS)

Documents and Forms

Document Name Document Type
Attachment A-1 NAS Questionnaire.docx Other-New Applicant Survey Questionn
Attachment A-5 Information Sheet and Consent Form 06172024.pptx Other-Information and Consent Form
Attachment A-11 Privacy Act Statement - Web Survey 06172024.jpg Other-Privacy Act Statement

Information Collection (IC) Details

IC Title:	Internet Survey (including informed consent and screener)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-New Applicant Survey Questionnaire	Attachment A-1 NAS Questionnaire.docx	Yes	Yes	Fillable Fileable Signable
Other-Information and Consent Form	Attachment A-5 Information Sheet and Consent Form 06172024.pptx	No		Printable Only
Other-Privacy Act Statement	Attachment A-11 Privacy Act Statement - Web Survey 06172024.jpg	No		Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	2,917	2,917
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.