Information Collection

California Health Interview Survey 2007

IC 178950 under ICR 200703-0925-002 · OMB 0925-0578.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 California Health Interview Survey 2007	Form
Attachment 2[5]_6-1-07.doc	Other-Updated Attachment 2
1 Survey Attachment 2[3][1].doc	Form
1 (Updated) Survey (Updated) Attach 5_Update CHIS 2007 QUESTIONNAIRE.pdf	Form

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	Survey	Attachment 2[3][1].doc	No	No	Paper Only
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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,015

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	4,015	4,015
Annual IC Time Burden (Hours)	54	54
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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