Information Collection

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

IC 3428 under ICR 200809-0607-001 · OMB 0607-0404.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0404 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form BC-1294(D) Field Representative Exit Questionnaire/Decennial Field Staff Exit Questionnaire/Continuous Measurement Exit Questionnaire	Form
BC1294 Changes.doc	Other-Proposed Changes to BC-1294
BC1294D changes.doc	Other-Proposed Changes to BC-1294(D)
BC-1294(D) Decennial Field Staff Exit Questionnaire BC-1294(D).pdf	Form
BC-1294(CM) Coverage Measurement Exit Questionnaire bc1294ccm.pdf	Form
BC-1294 Field Representative Exit Questionnaire BC-1294.pdf	Form

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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?	Electronic Capability
Form	BC-1294(D)	Decennial Field Staff Exit Questionnaire	BC-1294(D).pdf	No	Paper Only
Form	BC-1294	Field Representative Exit Questionnaire	BC-1294.pdf	No	Paper Only
Other-Proposed Changes to BC-1294			BC1294 Changes.doc	No	Paper Only
Other-Proposed Changes to BC-1294(D)			BC1294D changes.doc	No	Paper Only
Form	BC-1294(CM)	Coverage Measurement Exit Questionnaire	bc1294ccm.pdf	No	Paper Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,500

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,500	500	1,355	645
Annual IC Time Burden (Hours)	393	83	226	84
Annual IC Cost Burden (Dollars)	0	0	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.