View Information Collection (IC)

View Information Collection (IC)

IC Title:	CEX - Proof of Concept Test	Agency IC Tracking Number:

Is this a Common Form? No		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
Other-Instrument Specifications			Attachment A1 - POC Instrument Specifications.docx		Yes	Yes	Fillable Fileable
Other-Diary Screenshots			Attachment A2 - Electronic Diary Screen Shots.docx		Yes	Yes	Fillable Fileable
Other-Instrument Requirements			Attachment A3 - Diary 2015 Inst Reqts - COVERAGE.docx		Yes	Yes	Fillable Fileable
Form	Attachment 10	POC Debriefing Questions	Attachment A10 - POC Respondent Debriefing Questions_final.docx		No		Printable Only

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: 450	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	1,350	0	1,350	0	0	0
Annual IC Time Burden (Hours)	1,313	0	1,313	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment A - Gemini Proof of Concept Test Overview	Attachment A - Gemini Proof of Concept Test Overview_final.docx	05/11/2015
Attachment 4 - Advance Letter	Attachment A4 - POC Advanced Letter_final.docx	05/11/2015
Attachment 7 _ Email Template	Attachment A7 - Email Template.docx	05/11/2015
Attachment 11 - Analysis Plan	Attachment A11 - Analysis Plan_final.docx	05/11/2015
Attachment A5 - CE POC Debit Card Sleeve	Attachment A5 - CE POC Debit Card Sleeve.pdf	05/12/2015
Attachment 6 - Records Interview Checklist	Attachment A6 - Records Interview Checklist.pdf	05/12/2015
Attachment 8 - POC E-Diary User Guide	Attachment A9 - POC Electronic Diary video tutorial script_omb.docx	05/12/2015
Attachment A9 - POC Electronic Diary video tutorial script	Attachment A9 - POC Electronic Diary video tutorial script_omb.docx	05/12/2015

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