Information Collection

Health Measures at Home Study

IC 202801 under ICR 201010-0920-007 · OMB 0920-0237.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0237 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A - HMHS_061412.doc	Instruction
HMHS 2012 methodology study sup st_061412.doc Supporting Statement	IC Document
HMHS methodology study cover letter_061412.doc Home Study Methodology cover letter	IC Document

IC Title:

Health Measures at Home Study

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment A - HMHS_061412.doc		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the US Population

FR Citation: 49 FR 37693

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	100	0	0	0	0	0
Annual IC Time Burden (Hours)	199	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	HMHS 2012 methodology study sup st_061412.doc	06/19/2012
Home Study Methodology cover letter	HMHS methodology study cover letter_061412.doc	06/19/2012

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