View Information Collection (IC)

View Information Collection (IC)

IC Title:	2019 AHS Cognitive 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	1	Protocol and Questionnaire	AHS 2019 Protocol_Round 1_FINAL_03272018_clean.docx		No		Fillable Fileable

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
Recruitment Screener	Enclosure 2 - 2019 AHS Screener_02282018.docx	03/01/2018
Consent Form	Enclosure 4 - Consent Form_AHS 2019_ 02282018.docx	03/01/2018
Recruitment Ads	Enclosure 3a - AHS Recruiting Ads_BOC Email and Craigslist_02282018.pdf	03/01/2018
Recruitment Flyer	Enclosure 3b - AHS Recruiting Ad_Flyer_02282018.pdf	03/01/2018
OMB Memo	OMB Memo_AHS_FINAL_02282018.docx	03/22/2018

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