View Information Collection (IC)

View Information Collection (IC)

IC Title:	NYCHVS Cognitive Interviews	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 V1 (Owner)	Enclosure 1_Owner Protocol_revised.docx		No		Fillable Fileable
Form and Instruction	2	Protocol V2 (Renter)	Enclosure 2_Renter Protocol_revised.docx		No		Fillable Fileable
Form and Instruction	3	Flash Cards	Enclosure 4_Flash Cards.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: 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)	108	0	108	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo	OMB Memo_NYCHVS 2021 Redesign 190604.docx	06/05/2019
Recruitment Screener	Enclosure 3_Screener.docx	06/05/2019
Consent Form	Enclosure 5_Consent Form.docx	06/05/2019
Voucher Form	Enclosure 6_Payment Voucher.doc	06/05/2019

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