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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Cognitive Testing
Agency IC Tracking Number:
0920-0621-22DZ
Is this a Common Form?
No
IC Status:
Modified
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
Instruction
Cognitive Testing for NYTS.docx
No
Fillable Fileable
Form and Instruction
0920-0621
NYTS Cognitive Testing Parent/ Guardian Screener
Attachment R2_NYTS Cog Testing Parent Screener_(2022.03.29).docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0621
NYTS Cognitive Testing Youth Screener
Attachment R5_NYTS Cog Testing Youth Screener_(2022.03.29).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:
FR Citation:
Number of Respondents:
40
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
40
0
0
0
0
40
Annual IC Time Burden (Hours)
80
0
0
0
0
80
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
NYTS Cognitive Testing Parent/ Guardian Consent
Attachment R3_Parental Consent_(2022.02.23).docx
03/23/2022
Parent/Guardian Email and Youth Informed Consent for Cognitive Interviews
Attachment R6_Youth Consent_(2022.03.21).docx
03/23/2022
NYTS Cognitive Testing Protocol
Attachment R1_Cognitive Testing Protocol (2022.03.21).docx
03/23/2022
NYTS Cognitive Testing Notice of Non-Selection
Attachment R7_Notice of Non-Selection_(2022.03.21).docx
03/23/2022
NYTS Cognitive Testing Guides
Attachment R8_Cognitive Guides_(2022.03.21).docx
03/23/2022
NYTS Interviewer Guide – Item Set 1
Attachment R8a_Cognitive Guide-Item Set 1_(2022.03.29).docx
04/05/2022
NYTS Interviewer Guide – Item Set 2
Attachment R8b_Cognitive Guide-Item Set 2_(2022.03.29).docx
04/05/2022
NYTS Interviewer Guide – Item Set 3
Attachment R8c_Cognitive Guide-Item Set 3_(2022.03.29).docx
04/05/2022
NYTS Cognitive Testing Invitation to Youth Screener
Attachment R4_Youth Screener Invite_(2022.03.21).docx
04/05/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.