Information Collection

Household Enumeration

IC 182189 under ICR 200901-0925-003 · OMB 0925-0584.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0584 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Household Enumeration	Form and Instruction
1 Personal Identifiers Personal Identifiers_07-13-07.doc	Form and Instruction
2 Screen and Roster Screen and Roster_07-30-07.doc	Form and Instruction

IC Title:

Household Enumeration

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Personal Identifiers	Personal Identifiers_07-13-07.doc		Yes	Yes	Paper Only
Form and Instruction	2	Screen and Roster	Screen and Roster_07-30-07.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,191

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	Previously Approved
Annual Number of Responses for this IC	4,191	4,191
Annual IC Time Burden (Hours)	712	712
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.