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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
2016 American Community Survey Respondent Burden Testing
Agency IC Tracking Number:
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
13 CFR 141, 193 (To search for a specific CFR, visit the
Code of Federal Regulations.
)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
CAI Group 1 Version 1
CAI Group 1 Version 1
Attachment B 2016 ACS Respondent Burden Testing_FINAL Protocol_ CAI Group 1 Version 1_to CB 042516.docx
Yes
Yes
Paper Only
Form and Instruction
CAI Group 1 Version 2
CAI Group 1 Version 2
Attachment C 2016 ACS Respondent Burden Testing_FINAL Protocol_CAI Group 1 Version 2_to CB 042516.docx
Yes
Yes
Paper Only
Form and Instruction
Internet Group 1 Version 1
Internet Group 1 Version 1
Attachment D 2016 ACS Respondent Burden Testing_FINAL Protocol_Internet Group 1 Version 1_to CB 042516.docx
Yes
Yes
Paper Only
Form and Instruction
Internet Group 1 Version 2
Internet Group 1 Version 2
Attachment E 2016 ACS Respondent Burden Testing_FINALT Protocol_Internet Group 1 Version 2_to CB 042516.docx
Yes
Yes
Paper Only
Form and Instruction
CAI Group 2 Version 1
CAI Group 2 Version 1
Attachment F 2016 ACS Respondent Burden Testing_FINAL Protocol_CAI Group 2 Version 1_to CB_042516.docx
Yes
Yes
Paper Only
Form and Instruction
CAI Group 2 Version 2
CAI Group 2 Version 2
Attachment G 2016 ACS Respondent Burden Testing_FINAL Protocol_CAI Group 2 Version 2_ to CB_042516.docx
Yes
Yes
Paper Only
Form and Instruction
Internet Group 2 Version 2
Internet Group 2 Version 2
Attachment I 2016 ACS Respondent Burden Testing_FINAL Protocol_Internet Group 2 Version 2_to CB_042516.docx
Yes
Yes
Paper Only
Form and Instruction
CAI Group 3 Version 1
CAI Group 3 Version 1
Attachment J 2016 ACS Respondent Burden Testing_FINAL Protocol_CAI Group 3 Version 1_to CB_042516.docx
Yes
Yes
Paper Only
Form and Instruction
CAI Group 3 Version 2
CAI Group 3 Version 2
Attachment K 2016 ACS Respondent Burden Testing_FINAL Protocol_DRAFT CAI Group 3 Version 2_to CB_042516.docx
Yes
Yes
Paper Only
Form and Instruction
Paper Group 3 Version 1
Paper Group 3 Version 1
Attachment L 2016 ACS Respondent Burden Testing_FINAL Protocol_Paper Group 3 Version 1_to CB_042516.docx
Yes
Yes
Paper Only
Form and Instruction
Paper Group 3 Version 2
Paper Group 3 Version 2
Attachment M 2016 ACS Respondent Burden Testing_FINAL Protocol_Paper Group 3 Version 2_to CB_042516.docx
Yes
Yes
Paper Only
Form and Instruction
Internet Group 2 Version 1
Internet Group 2 Version 1
Attachment H 2016 ACS Respondent Burden Testing_FINAL Protocol_Internet Group 2 Version 1_to CB_042516.docx
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Government
Subfunction:
Central Records & Statistical Mgt
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
72
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
72
0
72
0
0
0
Annual IC Time Burden (Hours)
75
0
75
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Recruitment Screener
Attachment A ACS Respondent Burden Testing_FINAL Recruitment Plan_to CB 042516.docx
04/26/2016
Roster
Attachment N ACS Cog Test CAI Roster_revised_042516.doc
04/26/2016
CAI_V1
Attachment O CAI_V1_Group 1 and 2.docx
04/26/2016
CAI_V2
Attachment P CAI_V2_Group 1 and 2.docx
04/26/2016
CAI_V1_Group 3
Attachment Q CAI_V1_Group 3.doc
04/26/2016
CAI_V2 Group 3
Attachment R CAI_V2_Group 3.doc
04/26/2016
Internet Version 1 Group 1
Attachment S Group 1 Version 1 Internet Screens.pdf
04/26/2016
Interent Group 1 Version 2
Attachment T Group 1 Version 2 Internet Screens.pdf
04/26/2016
Internet Group 2 Version 1
Attachment U Group 2 Version 1 Internet Screens.pdf
04/26/2016
Internet Group 2 Version 2
Attachment V Group 2 Version 2 Internet Screens.pdf
04/26/2016
Paper Group 3 Version 1
Attachment W Paper Questionnaire Group 3 Version 1 ACS-1(X)G3V1_final.pdf
04/26/2016
Paper Group 3 Verion 2
Attachment X Paper Questionnaire Group 3 Version 2 ACS-1(X)G3V2_final.pdf
04/26/2016
Consent Form
Attachment Y 2016 ACS Respondent Burden Testing_FINAL Consent Form 042516.doc
04/26/2016
Memo
OMB Memo for Westat Cognitive Testing 5-20-2016.docx
05/20/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.