Fast Track Cover Letter

Request for Approval

TITLE OF INFORMATION COLLECTION: Weekly Behaviors Study

PURPOSE: This planned research is an online cognitive test of survey questions about behaviors in a “typical week” as well as “last week.” The goal is to capture how respondents understand the reference periods in regards to each behavior, and how respondents formulate their answers, including when they do not have a “typical” week in regards to one or more behaviors. The planned research will focus on assessing and improving behavioral survey questions with reference periods.

DESCRIPTION OF RESPONDENTS: A sample of the U.S. General Public for whom we have an email address.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Group

[ x] Other: Online Cognitive Testing

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name: ________________________________________________

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [x ] No

2. If Yes, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If Yes, has an up-to-date System of Records Notice (SORN) been published?

[ ] Yes [ ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [x ] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden
Remote Interviews	500	10 mins	84 hrs
Total Sample Reading Emails	5,000	3 min	250 hrs
Total			334 hrs

FEDERAL COST: The estimated annual cost to the Federal government is minimal.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe?

[x ] Yes [ ] No

Staff from the Center for Survey Measurement (CSM) will sample 5,000 email addresses from the Affinity Panel. This panel is comprised of people who have opted to participate in research studies for the U.S. Census Bureau; currently there are over 42,000 email addresses in the panel. We expect to achieve a 10% response rate, determined by experience with other recent studies, with a goal of 500 completes for this study. Participants can respond to the voluntary research study at a time convenient for them. They can also opt-out at any time.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[x] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[] Other:

2. Will interviewers or facilitators be used? [ ] Yes [X] No

1.      Line of Business – General Government

2.      Subfunction - Central Records & Statistical Mgt

3.      Number of Respondents for small entity - 0

4.      Affected Public – Individuals and Households

5.      Percentage of respondents reporting electronically – 100%

Please submit all instruments, instructions, correspondences (emails, letters, etc.) to respondents, and scripts as separate documents along with this request document.

Every instrument must have the following displayed –

OMB Control No. 0690-0030

Expiration Date: 6/30/17