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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Health Measures at Home Study	Agency IC Tracking Number:

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
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 %

	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

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.