Information Collection

2004 Coverage Research Followup Test

IC 3659 under ICR 200402-0607-006 · OMB 0607-0910.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

2004 Coverage Research Followup Test

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	DB-1301(CRFU)	No	No
Form	DB-1302	No	No
Form	DB-31(CRFU)	No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 16,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	16,000	16,000
Annual IC Time Burden (Hours)	4,800	4,800
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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

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