Information Collection

Persons interviewed with short and Proxy interview

IC 178498 under ICR 200701-0920-006 · OMB 0920-0740.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0740 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 2c Proxy int.doc	Instruction
MMP Attach 2B short questionnaire.doc	Instruction
Attachment 2d MMP non response collection.doc Attachment 2d	IC Document

IC Title:

Persons interviewed with short and Proxy interview

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment 2c Proxy int.doc		Yes	No	Printable Only
Instruction			MMP Attach 2B short questionnaire.doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 332

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	332	332
Annual IC Time Burden (Hours)	111	111
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 2d	Attachment 2d MMP non response collection.doc	06/07/2007

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