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Agenda
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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Success Sequence Interviews – Pre-Test
Agency IC Tracking Number:
OPRE
IC Status:
Unchanged
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-Screener
Instrument 1. Success Sequence Pre-test Screener 8.27.21_clean.docx
Yes
Yes
Fillable Fileable
Other-Interview and Debrief Protocol
Instrument 2. Success Sequence Pre-Test Interview and Debrief Protocol 8.27.21_clean.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Social Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
120
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
160
0
0
0
0
160
Annual IC Time Burden (Hours)
50
0
0
0
0
50
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SSA - Pretesting GenIC: Success Sequence
SSA Success Sequence Cog Pretesting.Aug 2021.docx
09/02/2021
SSB - Pretesting GenIC: Success Sequence
Success Sequence Generic SSB for Pre-test 8.27.21_clean (002).docx
09/02/2021
Appendix A. Success Sequence Pre-test Recruitment Materials
Appendix A. Success Sequence Pre-test Recruitment Materials 8.27.21_clean.docx
09/02/2021
Appendix B. Pre-test Consent Form
Appendix B. Pre-test Consent Form 8.27.21_clean.docx
09/02/2021
Appendix C. QualBoard Invitation Email Sample Screen Shots
Appendix C. QualBoard Invitation Email Sample Screen Shots.docx
09/02/2021
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.