California Health Interview Survey 2007

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	California Health Interview Survey 2007	Agency IC Tracking Number:

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	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 %

	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

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.