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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Congitive Testing of Confidentiality Pledges
Agency IC Tracking Number:
16AQC
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
Other-Testing Materials
Attach 1 Confid Pledge Materials 060316.docx
Yes
Yes
Fillable Fileable
Other-Screening script
Attach 3 Telehphone Screener.docx
Yes
Yes
Fillable Fileable
Form
none
Respondent data collection sheet
Attach 5 Resp Data Collect Sheet.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
Health and Demographic Surveys Conducted in Probability Samples of hte US Population
FR Citation:
49 FR 37693
Number of Respondents:
68
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
68
0
68
0
0
0
Annual IC Time Burden (Hours)
24
0
24
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Letter to Dr. Schwab
Confid Pledge 10-day letter 060616.docx
06/08/2016
Advertisement/flyer
Attach 2 Advertisement&flyer.docx
06/08/2016
Consent script
Attach 4 Informed Consent.docx
06/08/2016
Thank you letter
Attach 6 Thank You Letter.docx
06/08/2016
Special consent for expanded use of recordings
Attach 7 Spec Consent.docx
06/08/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.