Information Collection

Instruments

IC 189290 under ICR 200905-0607-006 · OMB 0607-0955.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0955 can be found here:

2010-03-26 - No material or nonsubstantive change to a currently approved collection
2010-03-19 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2010 Census ICP Ev Instruments	Form
Appendix A CICPE Advance Letter (No Phone)_071409.doc	Other-Advance letter sent to core sa
Appendix B CICPE Advance Letter (matched phone) 071409.doc	Other-Advance letter sent to oversam
Appendix C CICPE Advance Letter Conversion_SAQ_071409.doc	Other-Advance letter sent to core sa
Appendix D CICPE Advance Letter Panel_071909.doc	Other-Advance letter sent to oversam
Appendix E Participant Thank You Letter_071909.doc	Other-Conversion reminder letter sen
Appendix F_Conversion SAQ Letter_HTC.doc	Other-Conversion reminder letter sen
Appendix G_Advance letter panel participant.doc	Other-Advance letter for panel parti
Appendix H Postcard For Phone Number_072209.doc	Other-Postcard for address/phone upd
Appendix I_Informed Consent Statement_general.doc	Other-General Informed Consent state
Appendix J_Thank you letter.doc	Other-Thank you letter mailed to par
2010 Census ICP Ev 2010 Census ICP Evaluation Questionnaire Wave 1 2010 Census ICP Evaluation Questionnaire WAVE1 072109.DOC	Form
2010 Census ICP Ev 2010 Census ICP Evaluation Questionnaire Wave 2 2010 Census ICP Evaluation Questionnaire WAVE2 052709.doc	Form
2010 Census ICP Ev 2010 Census ICP Evaluation Questionnaire Wave 3 2010 Census ICP Evaluation Questionnaire WAVE3 052709.doc	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Instruments

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	2010 Census ICP Evaluation Questionnaire Wave 3	2010 Census ICP Evaluation Questionnaire Wave 3	2010 Census ICP Evaluation Questionnaire WAVE3 052709.doc	Yes	Yes	Fillable Fileable
Other-Advance letter for panel participants			Appendix G_Advance letter panel participant.doc	No		Paper Only
Other-Advance letter sent to core sample households with matched phone number			Appendix A CICPE Advance Letter (No Phone)_071409.doc	No		Paper Only
Other-Advance letter sent to oversample households with matched phone number			Appendix B CICPE Advance Letter (matched phone) 071409.doc	No		Paper Only
Form	2010 Census ICP Evaluation Questionnaire Wave 1	2010 Census ICP Evaluation Questionnaire Wave 1	2010 Census ICP Evaluation Questionnaire WAVE1 072109.DOC	Yes	Yes	Fillable Fileable
Form	2010 Census ICP Evaluation Questionnaire Wave 2	2010 Census ICP Evaluation Questionnaire Wave 2	2010 Census ICP Evaluation Questionnaire WAVE2 052709.doc	Yes	Yes	Fillable Fileable
Other-General Informed Consent statement to be included in interviewer scripts			Appendix I_Informed Consent Statement_general.doc	No		Paper Only
Other-Thank you letter mailed to participants following interview			Appendix J_Thank you letter.doc	No		Paper Only
Other-Advance letter sent to core sample households without a phone number match			Appendix C CICPE Advance Letter Conversion_SAQ_071409.doc	No		Paper Only
Other-Advance letter sent to oversample households without a phone number match			Appendix D CICPE Advance Letter Panel_071909.doc	No		Paper Only
Other-Conversion reminder letter sent to core sample households after CATI dialing			Appendix E Participant Thank You Letter_071909.doc	No		Paper Only
Other-Postcard for address/phone updates			Appendix H Postcard For Phone Number_072209.doc	No		Paper Only
Other-Conversion reminder letter sent to oversample households after CATI dialing			Appendix F_Conversion SAQ Letter_HTC.doc	No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 11,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 71 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	11,200	11,200
Annual IC Time Burden (Hours)	7,100	7,100
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.