Information Collection

2012 Well-being module

IC 198728 under ICR 201108-1220-001 · OMB 1220-0185.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1220-0185 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
A - WBM questionnaire.doc	Other-CATI
C1 Advance letter.pdf Advance letter	IC Document
C2 Advance letter_incentive cases.pdf Advance letter incentive cases	IC Document
C3 Advance Brochure.pdf Advance Brochure	IC Document
J1 refusal conv_confidentiality.doc refusal conv_confidentiality	IC Document
J2 refusal conv_why me.doc refusal conv_why me	IC Document
J3 refusal conv_tired CPS.doc refusal conv_tired CPS	IC Document
J4 refusal conv_too busy.doc refusal conv_too busy	IC Document
J5 refusal conv_gatekeeper.doc refusal conv_gatekeeper	IC Document

IC Title:

2012 Well-being module

Agency IC Tracking Number:

Is this a Common Form? No

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
Other-CATI			A - WBM questionnaire.doc		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12,800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12,800	12,800
Annual IC Time Burden (Hours)	1,067	1,067
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Advance letter	C1 Advance letter.pdf	08/02/2011
Advance letter incentive cases	C2 Advance letter_incentive cases.pdf	08/02/2011
Advance Brochure	C3 Advance Brochure.pdf	08/02/2011
refusal conv_confidentiality	J1 refusal conv_confidentiality.doc	08/02/2011
refusal conv_why me	J2 refusal conv_why me.doc	08/02/2011
refusal conv_tired CPS	J3 refusal conv_tired CPS.doc	08/02/2011
refusal conv_too busy	J4 refusal conv_too busy.doc	08/02/2011
refusal conv_gatekeeper	J5 refusal conv_gatekeeper.doc	08/02/2011

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