Information Collection

Usability Survey

IC 269802 under ICR 202407-0920-009 · OMB 0920-1438.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1438 can be found here:

2025-05-14 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Document Name Document Type
Form 0920-24CB Usability Survey Form
Form 0920-24CB Usability Survey Form
0920-24CB Usability Survey_Online_English Attachment 08h_Usability Survey_Online_English.docx Form
0920-24CB Usability Survey_Online_English Attachment 08h_Usability Survey_Online_English.docx Form
0920-24CB Usability Survey_Online_Spanish Attachment 08i_Usability Survey_Online_Spanish.docx Form
0920-24CB Usability Survey_Online_Spanish Attachment 08i_Usability Survey_Online_Spanish.docx Form
Attachment 08a_Usability Survey_Pre-Notification Email_English.docx Usability Survey_Pre-Notification Email_English IC Document
Attachment 08a_Usability Survey_Pre-Notification Email_English.docx Usability Survey_Pre-Notification Email_English IC Document
Attachment 08b_Usability Survey_Pre-Notification Email_Spanish.docx Usability Survey_Pre-Notification Email_Spanish IC Document
Attachment 08b_Usability Survey_Pre-Notification Email_Spanish.docx Usability Survey_Pre-Notification Email_Spanish IC Document
Attachment 08c_Usability Survey_Email with Survey Link_English.docx Usability Survey_Email with Survey Link_English IC Document
Attachment 08c_Usability Survey_Email with Survey Link_English.docx Usability Survey_Email with Survey Link_English IC Document
Attachment 08d_Usability Survey_Email with Survey Link_Spanish.docx Usability Survey_Email with Survey Link_Spanish IC Document
Attachment 08d_Usability Survey_Email with Survey Link_Spanish.docx Usability Survey_Email with Survey Link_Spanish IC Document
Attachment 08e_Usability Survey_Consent Statement_English.docx Usability Survey_Consent Statement_English IC Document
Attachment 08e_Usability Survey_Consent Statement_English.docx Usability Survey_Consent Statement_English IC Document
Attachment 08g_Usability Survey_Paper_English.docx Usability Survey_Paper_English IC Document
Attachment 08g_Usability Survey_Paper_English.docx Usability Survey_Paper_English IC Document
Attachment 08j_Usability Survey_Reminder Email_English.docx Usability Survey_Reminder Email_English IC Document
Attachment 08j_Usability Survey_Reminder Email_English.docx Usability Survey_Reminder Email_English IC Document
Attachment 08i_Usability Survey_Online_Spanish.docx Usability Survey_Online_Spanish IC Document
Attachment 08i_Usability Survey_Online_Spanish.docx Usability Survey_Online_Spanish IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Usability Survey	Agency IC Tracking Number:	0920-24CB

Is this a Common Form? No		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	0920-24CB	Usability Survey_Online_English	Attachment 08h_Usability Survey_Online_English.docx		Yes	Yes	Fillable Fileable
Form	0920-24CB	Usability Survey_Online_Spanish	Attachment 08i_Usability Survey_Online_Spanish.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	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	300	300
Annual IC Time Burden (Hours)	90	90
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Usability Survey_Pre-Notification Email_English	Attachment 08a_Usability Survey_Pre-Notification Email_English.docx	08/02/2024
Usability Survey_Pre-Notification Email_Spanish	Attachment 08b_Usability Survey_Pre-Notification Email_Spanish.docx	08/02/2024
Usability Survey_Email with Survey Link_English	Attachment 08c_Usability Survey_Email with Survey Link_English.docx	08/02/2024
Usability Survey_Email with Survey Link_Spanish	Attachment 08d_Usability Survey_Email with Survey Link_Spanish.docx	08/02/2024
Usability Survey_Consent Statement_English	Attachment 08e_Usability Survey_Consent Statement_English.docx	08/02/2024
Usability Survey_Paper_English	Attachment 08g_Usability Survey_Paper_English.docx	08/02/2024
Usability Survey_Reminder Email_English	Attachment 08j_Usability Survey_Reminder Email_English.docx	08/02/2024
Usability Survey_Online_Spanish	Attachment 08i_Usability Survey_Online_Spanish.docx	08/02/2024

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