View Information Collection (IC)

View Information Collection (IC)

Cognitive and Usability Evaluation of PHMSA 5800 Form
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Revised form Attachment A1_5800_revised form_122019.pdf No   Fillable Fileable
Form and Instruction 2 Existing Form Attachment A2_5800_existing Form_010105.pdf No   Fillable Fileable
Form and Instruction 3 Online version of existing form Attachment A3_5800online form.pdf No   Fillable Fileable

General Government Central Records & Statistical Mgt

 

50 0
   
Private Sector Businesses or other for-profits
 
   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 50 0 50 0 0 0
Annual IC Time Burden (Hours) 63 0 63 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
OMB Memo PHMSA OMB draft letter_192020.docx 01/14/2020
Usability Consent Form Attachment B1_Consent form_Usability and eyetracking.docx 01/14/2020
Cognitive Consent Form Attachment B2_Consent form_Cognitive testing.docx 01/14/2020
Protocol Attachment C_PHMSA_Testing Protocol_1920.docx 01/14/2020
Demographic Questionnaire Attachment D_Demographic Questionnaire.docx 01/14/2020
Computer Use Questionnaire Attachment E_Computer use and Internet Experience questionnaire.docx 01/14/2020
Satisfaction Questionnaire Attachment F_Satisfaction questionnaire.docx 01/14/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.