Usability Testing for the National

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0047 can be found here:

Documents and Forms

Document Name Document Type
Form 17wl Usability Testing for the National Form and Instruction
Attachment B - Discussion Guide (remote and in-person).docx Instruction
17wl Attachment A - Respondent Screeners Attachment A - Respondent Screeners.docx Form and Instruction
0923-0047 NCEH-ATSDR Generic Clearance EPHTN.pdf 0923-0047 NCEH-ATSDR Generic Clearance EPHTN IC Document

Information Collection (IC) Details

IC Title:	Usability Testing for the National	Agency IC Tracking Number:	17WL

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	17wl	Attachment A - Respondent Screeners	Attachment A - Respondent Screeners.docx		Yes	Yes	Fillable Printable
Instruction			Attachment B - Discussion Guide (remote and in-person).docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 136	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	136	136
Annual IC Time Burden (Hours)	44	44
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
0923-0047 NCEH-ATSDR Generic Clearance EPHTN	0923-0047 NCEH-ATSDR Generic Clearance EPHTN.pdf	02/28/2017

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