Information Collection

User Experience Interview

IC 269803 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⚠️ Notice: This information collection may be referencing outdated material.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 User Experience Interview	Form
Form 0920-24CB User Experience Interview	Form
0920-24CB User Experience Interviews_Interview Guide_English Attachment 09e_User Experience Interviews_Interview Guide_English.docx	Form
0920-24CB User Experience Interviews_Interview Guide_English Attachment 09e_User Experience Interviews_Interview Guide_English.docx	Form
0920-24CB User Experience Interviews_Interview Guide_Spanish Attachment 09f_User Experience Interviews_Interview Guide_Spanish.docx	Form
0920-24CB User Experience Interviews_Interview Guide_Spanish Attachment 09f_User Experience Interviews_Interview Guide_Spanish.docx	Form
Attachment 09a_User Experience Interviews_Recruitment Email_English.docx User Experience Interviews_Recruitment Email_English	IC Document
Attachment 09a_User Experience Interviews_Recruitment Email_English.docx User Experience Interviews_Recruitment Email_English	IC Document
Attachment 09b_User Experience Interviews_Recruitment Email_Spanish.docx User Experience Interviews_Recruitment Email_Spanish	IC Document
Attachment 09b_User Experience Interviews_Recruitment Email_Spanish.docx User Experience Interviews_Recruitment Email_Spanish	IC Document
Attachment 09c_User Experience Interviews_Consent Statement_English.docx User Experience Interviews_Consent Statement_English	IC Document
Attachment 09c_User Experience Interviews_Consent Statement_English.docx User Experience Interviews_Consent Statement_English	IC Document
Attachment 09d_User Experience Interviews_Consent Statement_Spanish.docx User Experience Interviews_Consent Statement_Spanish	IC Document
Attachment 09d_User Experience Interviews_Consent Statement_Spanish.docx User Experience Interviews_Consent Statement_Spanish	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

User Experience Interview

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	User Experience Interviews_Interview Guide_English	Attachment 09e_User Experience Interviews_Interview Guide_English.docx		Yes	Yes	Fillable Fileable
Form	0920-24CB	User Experience Interviews_Interview Guide_Spanish	Attachment 09f_User Experience Interviews_Interview Guide_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: 30

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	30	30
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
User Experience Interviews_Recruitment Email_English	Attachment 09a_User Experience Interviews_Recruitment Email_English.docx	08/02/2024
User Experience Interviews_Recruitment Email_Spanish	Attachment 09b_User Experience Interviews_Recruitment Email_Spanish.docx	08/02/2024
User Experience Interviews_Consent Statement_English	Attachment 09c_User Experience Interviews_Consent Statement_English.docx	08/02/2024
User Experience Interviews_Consent Statement_Spanish	Attachment 09d_User Experience Interviews_Consent Statement_Spanish.docx	08/02/2024

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