Information Collection

2013 Survey of Income and Program Participation Event History Calendar (SIPP-EHC) Field Test

IC 190057 under ICR 201208-0607-004 · OMB 0607-0957.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SIPP EHC FORM Part 2013 Survey of Income and Program Participation Event History Calendar (SIPP-EHC) Field Test	Form
SIPP-105(L)2013 - Attachment B.pdf	Other-Director's Letter
SIPP-105(L)(SP)2013 - Attachment C.pdf	Other-Director's Letter (Spanish)
SIPP-EHC Respondent Rules - Attachment D.pdf	Other-Respondent Rules
SIPP-EHC Respondent Rules - Attachment E (Spanish).pdf	Other-Respondent Rules (Spanish)
SIPP EHC-4006A_2012 - Attachment F.pdf	Other-Brochure "You Represent Your N
SIPP EHC-4006A_2012 (SP) - Attachment G.pdf	Other-Brochure "You Represent Your N
SIPP EHC FORM Part SIPP EHC FORM Part 1 2013 SIPP-EHC Items Booklet - Attachment A Part 1.pdf	Form
SIPP EHC FORM Part SIPP EHC FORM Part 2 (EHC Items) 2013 SIPP-EHC Items Booklet - Attachment A Part 2 (EHC items).pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SIPP EHC FORM Part 1	SIPP EHC FORM Part 1	2013 SIPP-EHC Items Booklet - Attachment A Part 1.pdf	Yes	Yes	Fillable Fileable
Form	SIPP EHC FORM Part 2 (EHC Items)	SIPP EHC FORM Part 2 (EHC Items)	2013 SIPP-EHC Items Booklet - Attachment A Part 2 (EHC items).pdf	Yes	Yes	Fillable Fileable
Other-Director's Letter			SIPP-105(L)2013 - Attachment B.pdf	Yes	Yes	Fillable Fileable
Other-Director's Letter (Spanish)			SIPP-105(L)(SP)2013 - Attachment C.pdf	Yes	Yes	Fillable Fileable
Other-Respondent Rules			SIPP-EHC Respondent Rules - Attachment D.pdf	Yes	Yes	Fillable Fileable
Other-Respondent Rules (Spanish)			SIPP-EHC Respondent Rules - Attachment E (Spanish).pdf	Yes	Yes	Fillable Fileable
Other-Brochure "You Represent Your Nation"			SIPP EHC-4006A_2012 - Attachment F.pdf	Yes	Yes	Fillable Fileable
Other-Brochure "You Represent Your Nation" (Spanish)			SIPP EHC-4006A_2012 (SP) - Attachment G.pdf	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: 6,300

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	Previously Approved
Annual Number of Responses for this IC	6,300	840	5,460
Annual IC Time Burden (Hours)	6,300	840	5,460
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.