Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Cognitive Testing of ASPE Criminal Justice System Questions
Agency IC Tracking Number:
0920-0222 (18JY)
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-WORD
Attachment 1a - Instrument 092117.docx
No
Paper Only
Other-WORD
Attachment 3 - Telephone Screener 092117.docx
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of th US Population
FR Citation:
49 FR 37693
Number of Respondents:
117
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
117
0
117
0
0
0
Annual IC Time Burden (Hours)
45
0
45
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Att 1b_Survey Questions Reference/Justification
Attachment 1b- Item Justification 092117.docx
12/20/2017
Att 2_Advertisement Flyer
Attachment 2 - AdvFlyer 092117.docx
12/20/2017
Att 4_Respondent Data Collection Sheet
Attachment 4 - Resp Data Collect Sheet 092117.docx
12/20/2017
Att 5_Adult Informed Consent
Attachment 5 - Informed Consent 092117.docx
12/20/2017
Att 6_Thank you letter
Attachment 6 - Thank You Letter.docx
12/20/2017
10 day Letter
10-day letter ASPE Criminal Justice 121917.docx
01/02/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.