View Information Collection Request (ICR) Package
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Brief and OIRA conclusion
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IC List
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Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View Generic ICR - OIRA Conclusion
OMB Control No:
0607-0725
ICR Reference No:
201606-0607-003
Status:
Historical Active
Previous ICR Reference No:
201312-0607-004
Agency/Subagency:
DOC/CENSUS
Agency Tracking No:
Title:
Generic Clearance for Questionnaire Pretesting Research
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
09/09/2016
Retrieve Notice of Action (NOA)
Date Received in OIRA:
07/28/2016
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
09/30/2019
36 Months From Approved
09/30/2016
Responses
16,500
0
16,500
Time Burden (Hours)
16,500
0
16,500
Cost Burden (Dollars)
0
0
0
Abstract:
The research will be used by the Census Bureau and the survey sponsors to improve questionnaires and procedures, reduce respondent burden, and ultimately increase the quality of data collected in Census Bureau censuses and surveys.
Authorizing Statute(s):
US Code:
13 USC 131, 141, 161, 181, 182, 193,
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
80 FR 28929
11/13/2015
30-day Notice:
Federal Register Citation:
Citation Date:
81 FR 32720
05/24/2016
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
85
IC Title
Form No.
Form Name
2017 ABS Usability Testing
1
Instrument screenshots
2017 American Community Survey Respondent Burden Testing
Interviewer-Administered Survey Questions, Paper Survey Questions, Interviewer-Administered Roster Questions
Paper Survey Questions
,
Interviewer-Administered Survey Questions
,
Interviewer-Administered Roster Questions
2017 Annual Survey of Businesses Cog Testing
1
Annual Survey of Businesses Questionnaire
2017 Economic Census Debriefings
1
Econ Census Web Screens
2017 Economic Census New Question Testing Addendum
Petroleum Construction Natural Gas Questions
Petroleum Construction Natural Gas Questions
2017 Economic Census Usability Testing and Debriefs
1, 2, 3
Demographics Questionnaire
,
Computer Use and Internet Experience Questionnaire
,
Satisfaction Questionnaire
2017 FNS Usability Testing
1
Application
2017 NCVS Mail Materials Project
2017 PRA Testing
2017 SAS Cognitive Interviews
1
Draft Questions
2018 ABS Technology Module Cog Testing
3, 1, 2
ABS Questionnaire
,
ABS R and D Questionnaire
,
Attachment D - Technology Module Questionnaire
2018 ACS Respondent Burden Testing
1, 3, 2
ACS Questionnaire Up to Q28
,
ACS Questionnaire From Q29 V1
,
ACS Questionnaire From Q29 V2
2018 BRDIS Cognitive Testing
4, 2, 3, 1
BRDIS 2016
,
Geography Questions
,
Capitol Stock Questions
,
Consent Form
2018 Census Test GQE eResponse Debriefings
3, 1, 2, 4
2018 GQE eResponse Site
,
eResponse Reporting Template
,
Invitation Letter
,
eResponse User Manual
2018 Centurion Site Tutorial Videos Cog Testing
2, 1, 3
Video Screenshots
,
Usability Tasks
,
Video Satisfaction Questionnare
2018 MOPS Hospitals
1
Questionnaire
2018 NCVS PPCS Cognitive Interviews
1
Full Questionnaire
2018 NSCH Usability Evaluation
4, 5, 1, 2, 3, 6
Questionnaire V1
,
Questionnaire V2
,
Questionnaire V3
,
Questionnaire V4
,
Demographic Questionnaire
,
Satisfaction Questionnaire
2019 ABS Globalization Module Cognitive Testing
1
Globalization Module draft
2019 ABS Innovation Module Cognitive Testing
1, 2, 3, 4, 5, 6
Revised Innovation Module
,
Innovation Handout
,
Barriers and Drivers Handout
,
Business Strategies Handout
,
Digital Tech Cards
,
Tech Capabilities List
2019 ACS POW-HOA Cognitive Testing to Reduce Burden
1
Modified ACS Paper Form
2019 AHS Cognitive Testing
1
Protocol and Questionnaire
2019 AHS Housing Insecurity Cognitive Testing
1
Protocol and Questionnaire
2019 Generic Screener with UYC Pilot Screener
1
Screeners part A and part B
2019 SAS Telemedicine Cog Interviews
1, 2
Attachment A - Proposed Telemedicine Questions for SAS
,
Attachment C - SAS Questionnaire
2020 CBAMS Addendum
2, 1
Demographic Questionnaire
,
Internet and Mobile Experience Questionnaire
2020 CPEX Extending the Census Environment Cog Testing
1
Mailing Materials
2020 Census Vacant Unit Crowdsourcing Research
1
Online Instrument
2020 Privacy & Confidentiality Cognitive Testing
6, 1, 2, 3, 4, 5
2020 Census Draft w/ citizenship
,
2020 Census Draft w/o citizenship
,
2020 Census Follow Up Survey w/ citizenship
,
2020 Census Follow Up Survey w/o citizenship
,
Online Questionnaire w/ citizenship
,
Online Questionnaire w/o citizenship
2020 Respondent Privacy Cognitive Interviews
1
Privacy Concerns Questionnaire
2020 Respondent Privacy Cognitive Interviews Round 2
1
Privacy and Confidentiality Questionnaire
2020 Tracking Survey
3, 1, 2, 4, 5, 6
Cog Testing - Census Tracking Questionnaire
,
Cog Testing - Web Form of Census Tracking Questionnaire
,
Cog Testing - Demographics Questionnaire
,
Web Probe Testing - Language Questions for Web
,
Web Probe Testing - Screencap of Introduction to Web Survey
,
Web Probe Testing - Screencaps of Web Testing
ABS Telephone Respondent Debriefings
1
2017 ABS Questionnaire
ACES Machine Learning Debriefings
1
Screenshots of Instrument
ACES Robotics
1
Question
ACS Respondent Burden Cognitive Testing
1, 2, 3
Survey Questions
,
Roster Questions for Group 1
,
Roster Questions for Group 2
ACS Respondent Comment/Feedback Addendum
1, 2
Entire ACS Questionnaire
,
ACS Respondent Feedback items at end of ACS Questionnaire
ACS Respondent Perceptions of Burden
2, 1
Paper Survey
,
Follow Up Questions
ASM Robotics
1, 3, 4, 2
Version A Questions
,
Version B Questions
,
Version C Questions
,
Version D Questions
ASM Robotics Debriefings
1
Robotics Questions
ASPP Cognitive Interviews
1
Questionnaire
Addendum for IOE Mobile UI Project Phase 2
1
Test materials as seen by respondents
American Community Survey (ACS) Respondent Comment/Feedback
2017 ACS form, Comment and Feedback Question
2017 ACS form
,
Comment and Feedback Question
Annual Retail Trade Survey Cognitive Testing
1
Select Survey Items
BE-120 Cognitive Interviews
BE-120 V1, BE-120 V2, BE-120
Questionnaire
,
Version 1 Supplement
,
Version 2 Supplement
BE-125 Respondent Debriefings
1
Questionnaire
BRDI-M Respondent Debriefings
1
Protocol
BRDS Cognitive Testing
2, 1
Aritificial Intelligence Questionnaire
,
Leased / Temporary Employees Questionnaire
Business Unit Harmonization Phase 3
1
BUH MockUp
Business Unit Harmonization Project Case Studies
1
Protocol
Business Unit Harmonization Project Case Studies Addendum
1
Protocol
CBAMS Cognitive and Usability Interviews
2, 1, 3
Paper Questionnaire
,
Demographics Questionnaire
,
Usability Satisfaction Questionnaire
CEDSCI Usability Addendum
1, 2, 3, 4
Demographic Questionnaire
,
Internet Experience Questionnaire
,
Debriefing Questionnaire
,
Satisfaction Questionnaire
CEDSCI Usability Evaluation
Demographic Information, Debriefing Question, Internet and Smartphone Experience Questions
Demographic Information
,
Internet and Smartphone Experience Questions
,
Debriefing Question
CEDSCI Usability Evaluation Addendum
4, 3, 1, 2
Demographics Questionnaire
,
Internet Use Questionnaire
,
Debriefing Questionnaire
,
Satisfaction Questionnaire
CFS Debriefing Study
1
Questionnaire
CPS Food Security Supplement
1
Protocol and Questionnaire
Census Test Usability Testing Addendum
2, 1, 3, 4
Instrument Debriefing Screens
,
Demographics Questionnaire
,
Mobile Experience Questionnaire
,
Satisfaction Questionnaire
Cognitive Testing of Privacy Act Language
1, 2
Privacy Act Test Language and FAQ Context
,
Confidentiality Statements in English
Current Population Survey Computer and Internet Use (CPS CIU) Supplemental Test
CPS CIU Roster Questionnaire, CPS CIU Full Questionnaire
CPS CIU Roster Questionnaire
,
CPS CIU Full Questionnaire
Early Stage Scoping for the Commodity Flow Survey
1
2017 CFS Instrument
Econ Record Keep Study
1, 2
Example Chart
,
Example Survey Questions
FGP Econ Census Respondent Debriefings
1
FGP Questions from Econ Census
MEPS Cognitive Testing
4, 3, 1, 2
Form MEPS 10
,
Form MEPS 10s
,
Form MEPS 11
,
Form MEPS 11s
MEPS Telephone Interviews
1, 3, 4, 2
2018 MEPS-10 Form
,
2018 MEPS-10S Form
,
2017 MEPS-10 Form
,
2017 MEPS-10S Form
MEPS–IC Cog Testing
4, 1, 2, 3
MEPS-10
,
MEPS-10S
,
MEPS-11
,
MEPS-11S
Mobile UI Design Framework for Survey Operations – Phase 1, Study 2
1, 2
Experimental Info
,
Privacy Act Statement
NAPCS Debriefings
1
NAPCS Instrument Screens
NAPCS Questionnaire Field Test
2, 1
Questionnaire
,
Debriefing
NSCH Mail Materials Cognitive Testing
1
Mail Materials
NSCH Questionnaire Cognitive Interviews
4, 3, 2, 1
Screener Survey
,
Cognitive Interview Version 1
,
Cognitive Interview Version 2
,
Cognitive Interview Version 3
NSCH Questionnaire Cognitive Testing
3, 4, 6, 7, 8, 1, 2, 5
English Screener
,
English Topical Questionnaire 1
,
English Topical Questionnaire 2
,
English Topical Questionnaire 3
,
Spanish Screener
,
Spanish Topical Questionnaire 1
,
Spanish Topical Questionnaire 2
,
Spanish Topical Questionnaire 3
NSCH Screener Cognitive Interviews
1, 4, 8, 11, 2, 3, 5, 6, 7, 9, 10
Screener Card
,
Experimental Treatment B - NonPerforated Mockup 1
,
Experimental Treatment B - NonPerforated Mockup 2
,
Experimental Treatment B - Perforated Mockup 1
,
Experimental Treatment B - Perforated Mockup 2
,
Experimental Treatment C
,
Standard Treatments A and D
,
NonPerforated Mockup 1
,
NonPerforated Mockup 2
,
Perforated Mockup 1
,
Perforated Mockup 2
NSP Usability Testing
1, 2, 3, 4, 5
Log On Letter
,
Paper Questionnaire
,
Demographic Questionnaire
,
Mobile Experience Questionnaire
,
Satisfaction Questionnaire
NSSRN Cognitive Testing
Questionnaire, Screener
Questionnaire
,
Screener
NSSRN Usability Evaluation
2, 3, 4, 1
Demographics Questionnaire
,
Debriefing Questions
,
Satisfaction Questionnaire
,
NSSRN Questionnaire
NYCHVS Cognitive Interviews
3, 2, 1
Protocol V1 (Owner)
,
Protocol V2 (Renter)
,
Flash Cards
National Survey of Psychiatrists Cognitive Testing
1, 2, 4, 3
Questionnaire
,
Alternative Full page Coversheet w/ Questionnaire (beginning)
,
Alternative Cover Image 1
,
Alternative Cover Image 2
Pretest Medical Expenditure Panel Survey – Insurance Component (MEPS-IC)
MEPS – IC
Medical Expenditure Panel Survey – Insurance Component (MEPS-IC)
Quarterly Survey of Public Pensions Cognitive Testing
1
QSPP Draft Questionnaire
Recruitment Screener
Internet Screener, Telephone Recruitment Screener
Telephone Recruitment Screener
,
Internet Screener
SAS E-Commerce Respondent Debriefings
1
E-Commerce Questions
UYC Cog Testing and Focus Groups
1, 2
Focus Group Protocol
,
Cognitive Interviewing Protocol
Vacant Crowdsourcing Internet Study
5, 6, 9, 7, 1, 2, 4, 3, 8
Mailing Materials
,
Version 1 of Address Display
,
Version 2 of Address Display
,
Version 3 of Address Display
,
Version 4 of Address Display
,
Version 5 of Address Display
,
Version 6 of Address Display
,
Satisfaction with Instrument Questionnaire
,
Preference of Address Display Question
Web Satisfaction Questionnaire Development
Web Satisfaction Questionnaire
Web Satisfaction Questionnaire
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
16,500
16,500
0
0
0
0
Annual Time Burden (Hours)
16,500
16,500
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$0
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Jennifer Childs 301 763-4927
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
07/28/2016
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