Information Collection Request

Survey of Health Insurance and Program Participation (SHIPP)

ICR 201002-0607-003 · OMB 0607-0959 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form SHIPP Questionnair Survey of Health Insurance and Program Participation Form New Available
Census Emergency Letter to OMB.SHIPP 2-22-10.pdf Supplementary Document Uploaded 2010-02-22 Available
omb supporting statement part b.wpd Supporting Statement B Uploaded 2010-02-19 Available
omb supporting statement part a.wpd Supporting Statement A Uploaded 2010-02-19 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
192033 Survey of Health Insurance and Program Participation Form New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2010 6 Months From Approved
5,000 0 0
1,000 0 0
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Survey of Health Insurance and Program Participation SHIPP Questionnaire (CATI Specifications) SHIPP Questionnaire (CATI Specifications)

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 5,000 0 0 5,000 0 0
Annual Time Burden (Hours) 1,000 0 0 1,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No