Information Collection

Cognitive Testing

IC 214643 under ICR 202506-0910-008 · OMB 0910-0932.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0932 can be found here:

Documents and Forms

Document Name Document Type
OMB info for Cognitive Testing.docx Other-OMB Header and Burden Statemen

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Cognitive Testing	Agency IC Tracking Number:	0920-0621

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-OMB Header and Burden Statement			OMB info for Cognitive Testing.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	60	20	40
Annual IC Time Burden (Hours)	120	40	80
Annual IC Cost Burden (Dollars)	0	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.

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