Information Collection

California Health Interview Survey 2007

IC 178949 under ICR 200703-0925-002 · OMB 0925-0578.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1(Updated) California Health Interview Survey 2007	Form
Attachment 2[5]_6-1-07.doc	Other-Updated-Attachment 2
1 Survey Survey 1.doc	Form
1(Updated) Survey (Updated) Attach 5_Update CHIS 2007 QUESTIONNAIRE.pdf	Form
letters etc..pdf letters etc.	IC Document
Back-up Material.pdf Back-up Material	IC Document
IRB-CHIS.pdf IRB-CHIS	IC Document

IC Title:

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1(Updated)	Survey (Updated)	Attach 5_Update CHIS 2007 QUESTIONNAIRE.pdf	No		Paper Only
Other-Updated-Attachment 2			Attachment 2[5]_6-1-07.doc	No		Paper Only
Form	1	Survey	Survey 1.doc	No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 48,150

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	48,150	48,150
Annual IC Time Burden (Hours)	5,778	5,778
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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