Information Collection Request

Field Representative Exit Questionnaire/Decennial Field Staff Exit Questionnaire/Continuous Measurement Exit Questionnaire

ICR 200809-0607-001 · OMB 0607-0404 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form BC-1294(D) Field Representative Exit Questionnaire/Decennial Field Staff Exit Questionnaire/Continuous Measurement Exit Questionnaire Form Modified Available
Supporting StatementB.doc Supporting Statement B Uploaded 2009-01-27 Available
Supporting StatementA.doc Supporting Statement A Uploaded 2009-02-06 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
3428 Field Representative Exit Questionnaire/Decennial Field Staff Exit Questionnaire/Continuous Measurement Exit Questionnaire Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/29/2012 36 Months From Approved 02/28/2009
2,500 0 645
393 0 84
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Field Representative Exit Questionnaire/Decennial Field Staff Exit Questionnaire/Continuous Measurement Exit Questionnaire BC-1294(CM), BC-1294, BC-1294(D) Decennial Field Staff Exit Questionnaire ,   Field Representative Exit Questionnaire ,   Coverage Measurement Exit Questionnaire

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,500 645 0 500 1,355 0
Annual Time Burden (Hours) 393 84 0 83 226 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No