View Information Collection (IC)

View Information Collection (IC)

IC Title:	AHS Revised Modules Cog Testing	Agency IC Tracking Number:

IC Status: New

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	AHS Protocol	AHS Protocol	AHS FINAL Protocol_Round 1_05232016.docx		Yes	Yes	Paper Only
Form and Instruction	AHS Screener	AHS Screener	Recruitment Screener 160520.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: 35	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	35	0	35	0	0	0
Annual IC Time Burden (Hours)	53	0	53	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Memo	OMB Memo_FINAL.docx	05/23/2016
OMB Memo FINAL Revised	OMB Memo_FINAL (2)_SSP.docx	06/17/2016

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