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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
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 bc1294d.pdf Form
BC-1294(CM) Coverage Measurement Exit Questionnaire bc1294ccm.pdf Form
BC-1294 Field Representative Exit Questionnaire bc1294.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Other-Proposed Changes to BC-1294			BC1294 Changes.doc	No	Paper Only
Form	BC-1294(D)	Decennial Field Staff Exit Questionnaire	bc1294d.pdf	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
Form	BC-1294	Field Representative Exit Questionnaire	bc1294.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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,500	2,500
Annual IC Time Burden (Hours)	393	393
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.