Information Collection

General Population

IC 191539 under ICR 201006-0925-001 · OMB 0925-0618.

Documents and Forms

Document Name Document Type
Form 1 General Population Form
1 survey Attachment C_HIP_Survey_8-4-10.doc Form
2 survey Attachment D_Letters_Scripts_Email_8-4-10.doc Form
Attachment E_KN_CPS Comparison .pdf Attachment E_KN_CPS Comparison IC Document
Attachment F_GeoDiversity of Panel.pdf Attachment F_GeoDiversity of Panel IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	General Population	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	survey	Attachment C_HIP_Survey_8-4-10.doc		Yes	Yes	Paper Only
Form	2	survey	Attachment D_Letters_Scripts_Email_8-4-10.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD	FR Citation: 60 FR 4277

Number of Respondents: 3,250	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	3,250	3,250
Annual IC Time Burden (Hours)	1,073	1,073
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment E_KN_CPS Comparison	Attachment E_KN_CPS Comparison .pdf	05/19/2010
Attachment F_GeoDiversity of Panel	Attachment F_GeoDiversity of Panel.pdf	05/21/2010

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