Information Collection

Pretesting Questionnaires and Definitions Used to Classify Health Care Group Quarters

IC 259704 under ICR 202508-0607-002 · OMB 0607-0725.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0725 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Pretesting Questionnaires and Definitions Used to Classify Health Care Group Quarters	Form and Instruction
Form 1 Protocol Pretesting Questionnaires and Definitions Used to Classify Health Care Group Quarters	Form and Instruction
1 Protocol Enclosure 1 - Health Care GQs questionnaire and definitions protocol.docx	Form and Instruction
1 Protocol Enclosure 1 - Health Care GQs questionnaire and definitions protocol.docx	Form and Instruction
OMB letter - GQ health care cognitive testing_041223_clean.docx OMB Letter	IC Document
OMB letter - GQ health care cognitive testing_041223_clean.docx OMB Letter	IC Document
Enclosure 2 - Health Care GQs pretesting consent form_041223_clean.docx Consent Form	IC Document
Enclosure 2 - Health Care GQs pretesting consent form_041223_clean.docx Consent Form	IC Document

IC Title:

Pretesting Questionnaires and Definitions Used to Classify Health Care Group Quarters

Agency IC Tracking Number:

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 and Instruction	1				No		Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Letter		04/14/2023
Consent Form		04/14/2023

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

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