Information Collection

User Experience Interview

IC 269803 under ICR 202505-0920-004 · OMB 0920-1438.

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 Interviews_Interview Guide_English User Experience Interview	Form
Form 0920-24CB User Experience Interviews_Interview Guide_Spanish 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: Unchanged

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				Yes	Yes	Fillable Fileable
Form	0920-24CB				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	Previously Approved
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		08/02/2024
User Experience Interviews_Recruitment Email_Spanish		08/02/2024
User Experience Interviews_Consent Statement_English		08/02/2024
User Experience Interviews_Consent Statement_Spanish		08/02/2024

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

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