Information Collection

Usability Survey

IC 269802 under ICR 202407-0920-009 · OMB 0920-1438.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1438 can be found here:

2025-05-14 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-24CB Usability Survey	Form
Form 0920-24CB Usability Survey	Form
0920-24CB Usability Survey_Online_English Attachment 08h_Usability Survey_Online_English.docx	Form
0920-24CB Usability Survey_Online_English Attachment 08h_Usability Survey_Online_English.docx	Form
0920-24CB Usability Survey_Online_Spanish Attachment 08i_Usability Survey_Online_Spanish.docx	Form
0920-24CB Usability Survey_Online_Spanish Attachment 08i_Usability Survey_Online_Spanish.docx	Form
Attachment 08a_Usability Survey_Pre-Notification Email_English.docx Usability Survey_Pre-Notification Email_English	IC Document
Attachment 08a_Usability Survey_Pre-Notification Email_English.docx Usability Survey_Pre-Notification Email_English	IC Document
Attachment 08b_Usability Survey_Pre-Notification Email_Spanish.docx Usability Survey_Pre-Notification Email_Spanish	IC Document
Attachment 08b_Usability Survey_Pre-Notification Email_Spanish.docx Usability Survey_Pre-Notification Email_Spanish	IC Document
Attachment 08c_Usability Survey_Email with Survey Link_English.docx Usability Survey_Email with Survey Link_English	IC Document
Attachment 08c_Usability Survey_Email with Survey Link_English.docx Usability Survey_Email with Survey Link_English	IC Document
Attachment 08d_Usability Survey_Email with Survey Link_Spanish.docx Usability Survey_Email with Survey Link_Spanish	IC Document
Attachment 08d_Usability Survey_Email with Survey Link_Spanish.docx Usability Survey_Email with Survey Link_Spanish	IC Document
Attachment 08e_Usability Survey_Consent Statement_English.docx Usability Survey_Consent Statement_English	IC Document
Attachment 08e_Usability Survey_Consent Statement_English.docx Usability Survey_Consent Statement_English	IC Document
Attachment 08g_Usability Survey_Paper_English.docx Usability Survey_Paper_English	IC Document
Attachment 08g_Usability Survey_Paper_English.docx Usability Survey_Paper_English	IC Document
Attachment 08j_Usability Survey_Reminder Email_English.docx Usability Survey_Reminder Email_English	IC Document
Attachment 08j_Usability Survey_Reminder Email_English.docx Usability Survey_Reminder Email_English	IC Document
Attachment 08i_Usability Survey_Online_Spanish.docx Usability Survey_Online_Spanish	IC Document
Attachment 08i_Usability Survey_Online_Spanish.docx Usability Survey_Online_Spanish	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Usability Survey

Agency IC Tracking Number:

0920-24CB

Is this a Common Form? No

IC Status: New

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	0920-24CB	Usability Survey_Online_English	Attachment 08h_Usability Survey_Online_English.docx		Yes	Yes	Fillable Fileable
Form	0920-24CB	Usability Survey_Online_Spanish	Attachment 08i_Usability Survey_Online_Spanish.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

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
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	90	90
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Usability Survey_Pre-Notification Email_English	Attachment 08a_Usability Survey_Pre-Notification Email_English.docx	08/02/2024
Usability Survey_Pre-Notification Email_Spanish	Attachment 08b_Usability Survey_Pre-Notification Email_Spanish.docx	08/02/2024
Usability Survey_Email with Survey Link_English	Attachment 08c_Usability Survey_Email with Survey Link_English.docx	08/02/2024
Usability Survey_Email with Survey Link_Spanish	Attachment 08d_Usability Survey_Email with Survey Link_Spanish.docx	08/02/2024
Usability Survey_Consent Statement_English	Attachment 08e_Usability Survey_Consent Statement_English.docx	08/02/2024
Usability Survey_Paper_English	Attachment 08g_Usability Survey_Paper_English.docx	08/02/2024
Usability Survey_Reminder Email_English	Attachment 08j_Usability Survey_Reminder Email_English.docx	08/02/2024
Usability Survey_Online_Spanish	Attachment 08i_Usability Survey_Online_Spanish.docx	08/02/2024

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