Pretesting Questionnaires and Definitions Used to Classify Health Care Group Quarters

Generic Clearance for Questionnaire Pretesting Research

Documents and Forms

Document Name Document Type
Form 1 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
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

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Protocol	Enclosure 1 - Health Care GQs questionnaire and definitions protocol.docx		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 %

	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

Title	Document	Date Uploaded
OMB Letter	OMB letter - GQ health care cognitive testing_041223_clean.docx	04/14/2023
Consent Form	Enclosure 2 - Health Care GQs pretesting consent form_041223_clean.docx	04/14/2023

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