Non-Parcipating Household (Screened)

Attitudes toward Electronic Health Information Exchange and Associated Privacy and Security Aspects

Documents and Forms

Document Name Document Type
0990-Attachment_C_HISPC_Screener_2010_final_OMB#placeholder-V2.doc Other-sreener
0990-attitidestowardAttachment_B_Lit_Review_Bibliography.doc Bibliography IC Document

Information Collection (IC) Details

IC Title:	Non-Parcipating Household (Screened)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Other-sreener			0990-Attachment_C_HISPC_Screener_2010_final_OMB#placeholder-V2.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 22,845	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	22,845	22,845
Annual IC Time Burden (Hours)	762	762
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Bibliography	0990-attitidestowardAttachment_B_Lit_Review_Bibliography.doc	03/22/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.