Information Collection

Line 8 National Survey Resident Questionnaire

IC 183894 under ICR 200911-0920-003 · OMB 0920-0780.

Documents and Forms

Document Name Document Type
Form 8 Line 8 National Survey Resident Questionnaire Form and Instruction
8 National Survey Resident Questionnaire Attachment P-National Resident Questionnaire121907.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Line 8 National Survey Resident Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	8	National Survey Resident Questionnaire	Attachment P-National Resident Questionnaire121907.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Health Resources Utilization Statistics	FR Citation: 49 FR 37697

Number of Respondents: 750	Number of Respondents for Small Entity: 200

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-3,750	3,750
Annual IC Time Burden (Hours)	-1,875	1,875
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.