View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Survery of Respirator Use Cognitive Testing - Phase 1	Agency IC Tracking Number:	22105

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	Attachments 1-8	Survey Protocol - SRUP	Attachments - Survey Protocol SRUP.docx		Yes	Yes	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: 30	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	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	30	0	30	0	0	0
Annual IC Time Burden (Hours)	42	0	42	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Note to Reviewer - Survey of Respirator Use - Phase 1	Note to Reviewer - Survey of Respirator Use - Scoping and Phase 1.docx	12/18/2020
OMB memo survey protocol and scoping interviews Phase 1 - revised	Note to Reviewer - Survey of Respirator Use - Scoping and Phase 1 Final2...-clean.docx	02/16/2021

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