Information Collection

Main interview

IC 193332 under ICR 201006-0920-004 · OMB 0920-0865.

Documents and Forms

Document Name Document Type
Main interview Form
Main interview questionnaire Attachment F5 Main Survey Interview revised 08-30-2010.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Main interview	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
Form	none	Main interview questionnaire	Attachment F5 Main Survey Interview revised 08-30-2010.doc		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,457	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,457	2,457
Annual IC Time Burden (Hours)	1,966	1,966
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.