Information Collection

Cognitive Interviews

IC 214643 under ICR 202510-0910-002 · OMB 0910-0932.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0932 NYTS Att N4_Cognitive Testing Screeners_20240520a_clean.docx	Other-Cognitive Testing
0932 NYTS Att N4_Cognitive Testing Screeners_20240520a_clean.docx	Other-Cognitive Testing

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Other-Cognitive Testing					No		Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

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	60	60
Annual IC Time Burden (Hours)	120	120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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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