Information Collection

App G_Cognitive Laboratory Survey

IC 219906 under ICR 201601-0920-018 · OMB 0920-0822.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0822 can be found here:

Documents and Forms

Document Name Document Type
App E_Study Consent Form.docx App E_Study Consent Form IC Document
App F_Study Interview Protocol.docx App F_Study Protocol IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	App G_Cognitive Laboratory Survey	Agency IC Tracking Number:	16LV

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 3 CFR 241

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
App E_Study Consent Form	App E_Study Consent Form.docx	01/29/2016
App F_Study Protocol	App F_Study Interview Protocol.docx	01/29/2016

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