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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Cognitive Testing of ATUS Eldercare Questions for the Web
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
Attachment B
Cognitive Testing Protocol
Appendix B Cognitive Testing Protocol 12-3-2021.docx
Yes
No
Printable Only
Form and Instruction
Appendix E
Eligibility and Scheduling Screener
Appendix E Eligibility and Scheduling Screener 12-3-2021.docx
Yes
No
Printable Only
Form and Instruction
Appendix F
AmeriSpeak Omnibus Materials
Appendix F AmeriSpeak Omnibus Materials.docx
Yes
Yes
Fillable Fileable
Form and Instruction
Appendix A
ATUS Eldercare Wireframe
Appendix A ATUS Eldercare Wireframe 12-3-2021.docx
Yes
No
Printable Only
Instruction
Appendix C Consent Statement 12-8-2021.docx
Yes
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:
1,000
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
1,000
0
1,000
0
0
0
Annual IC Time Burden (Hours)
110
0
110
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Note to Reviewer - Cognitive Testing of the ATUS Eldercare Questions for the Web
Note to Reviewer - ATUS Eldercare OMB Clearance Package 12-7-2021.docx
12/08/2021
Appendix D Eldercare FAQ
Appendix D Eldercare FAQ 12-8-2021.docx
12/08/2021
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.