Information Collection

(CTP) [Wave 1 Survey] The Real Cost Monthly Implementation Assessment

IC 279955 under ICR 202507-0910-005 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 2a. MIA Wave 1 Survey_English_4.9.2026.docx	Other-Survey - English Version
Attachment 2a. MIA Wave 1 Survey_Spanish_4.9.2026.docx	Other-Survey - Spanish Version
Wave 1_MIA Stimuli - Scripts and Screenshots_4.9.2026.docx	Other-Stimuli - Scripts and Screensh
0910-0935_MIA Wave1_April 2026.docx Wave 1 - Gen IC Memo	IC Document

IC Title:

Agency IC Tracking Number:

CTP

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey - English Version	Yes	Yes	Fillable Printable
Other-Survey - Spanish Version	Yes	Yes	Fillable Printable
Other-Stimuli - Scripts and Screenshots	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 34,861

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	34,861	34,861
Annual IC Time Burden (Hours)	2,192	2,192
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Wave 1 - Gen IC Memo		04/21/2026

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

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