Bundled Website Usability Testings #1 (ASA24) and #2 (GEM)

Questionnaire Cognitive Interviewing and Pretesting (NCI)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0589 can be found here:

Documents and Forms

Document Name Document Type
Form 2 Bundled Website Usability Testings #1 (ASA24) and #2 (GEM) Form and Instruction
2 #2_GEM Attach 2C 2D Survey and Guide #2_Attach 2C 2D_Survey and Guide_GEM_FINAL.docx Form and Instruction
1 #1_ASA 24 Screener and Guide #1 Attach 1A and 1C Screener & Guide.docx Form and Instruction
Memo to OMB_Key To Bundled #1 and #2.doc Memo to OMB_Key To Bundled #1 and #2 IC Document
Gen IC Forms #1 and #2_ASA-24 & GEM Usability Testing.doc Gen IC Forms #1 and #2_ASA-24 & GEM Usability Testing IC Document
#1 Justif Memo Attach 1B 1D_5-18-2011.doc #1 Justif Memo Attach 1B 1D_ASA24_5-18-2011 IC Document
#2_Justifi Memo Attach 2A 2B_GEM_FINAL.docx #2_Justifi Memo Attach 2A 2B_GEM_FINAL IC Document
Gen IC Forms _1 and _2_ASA-24 & GEM Usability Testing_V2.doc REVISED Gen IC Forms #1 and #2 IC Document

Information Collection (IC) Details

IC Title:	Bundled Website Usability Testings #1 (ASA24) and #2 (GEM)	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	2	#2_GEM Attach 2C 2D Survey and Guide	#2_Attach 2C 2D_Survey and Guide_GEM_FINAL.docx		Yes	No	Fillable Printable
Form and Instruction	1	#1_ASA 24 Screener and Guide	#1 Attach 1A and 1C Screener & Guide.docx		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: SORN #09-25-0156, "Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD"	FR Citation: 67 FR 60743

Number of Respondents: 198	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	198	0	0	0	0	0
Annual IC Time Burden (Hours)	107	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Memo to OMB_Key To Bundled #1 and #2	Memo to OMB_Key To Bundled #1 and #2.doc	05/27/2011
Gen IC Forms #1 and #2_ASA-24 & GEM Usability Testing	Gen IC Forms #1 and #2_ASA-24 & GEM Usability Testing.doc	05/27/2011
#1 Justif Memo Attach 1B 1D_ASA24_5-18-2011	#1 Justif Memo Attach 1B 1D_5-18-2011.doc	05/27/2011
#2_Justifi Memo Attach 2A 2B_GEM_FINAL	#2_Justifi Memo Attach 2A 2B_GEM_FINAL.docx	06/01/2011
REVISED Gen IC Forms #1 and #2	Gen IC Forms _1 and _2_ASA-24 & GEM Usability Testing_V2.doc	06/16/2011

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