Information Collection

Main Survey

IC 202023 under ICR 201208-0990-002 · OMB 0990-0398.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0398 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HHS ONC Questionnaire FinalMain_080112.docx	Other-Survey
Spanish HHS ONC Questionnaire FinalMain_080112.docx	Other-Survey - Spanish
HHS ONC Survey Introduction and Consent Script_NORC 080112.docx Survey Script - English	IC Document
Spanish HHS ONC Survey Introduction and Consent Script_NORC 080112.docx Survey Script - Spanish	IC Document

IC Title:

Main Survey

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			HHS ONC Questionnaire FinalMain_080112.docx		Yes	Yes	Fillable Fileable
Other-Survey - Spanish			Spanish HHS ONC Questionnaire FinalMain_080112.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Survey Script - English	HHS ONC Survey Introduction and Consent Script_NORC 080112.docx	08/01/2012
Survey Script - Spanish	Spanish HHS ONC Survey Introduction and Consent Script_NORC 080112.docx	08/01/2012

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