Information Collection

2013 CPS ASEC Content Test

IC 204710 under ICR 201211-0607-002 · OMB 0607-0973.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Items Booklet - In 2013 CPS ASEC Content Test	Form
B. Confidentiality brochure.pdf	Other-Confidentiality Brochure
C. CPS ASEC Advanced letter.docx	Other-Advance Letter
E. Survey instrument flow document v7.vsd	Other-Survey Instrument Flow Documen
F. CPS ASEC 2013 flow doc_v25.docx	Other-Survey Instrument Path Diagram
M. Scripted scenario health insurance.docx	Other-Scripted Scenario - Health Ins
Items Booklet - He Items Booklet - Health Insurance D. Items Booklet - health insurance.pdf	Form
Items Booklet - In Items Booklet - Income & Other Questions G. Items Booklet - Income v2.pdf	Form

IC Title:

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Items Booklet - Income & Other Questions	Items Booklet - Income & Other Questions	G. Items Booklet - Income v2.pdf	Yes	Yes	Fillable Fileable
Other-Survey Instrument Flow Document			E. Survey instrument flow document v7.vsd	Yes	Yes	Fillable Fileable
Other-Survey Instrument Path Diagrams			F. CPS ASEC 2013 flow doc_v25.docx	Yes	Yes	Fillable Fileable
Other-Confidentiality Brochure			B. Confidentiality brochure.pdf	Yes	Yes	Fillable Fileable
Form	Items Booklet - Health Insurance	Items Booklet - Health Insurance	D. Items Booklet - health insurance.pdf	Yes	Yes	Fillable Fileable
Other-Advance Letter			C. CPS ASEC Advanced letter.docx	Yes	Yes	Fillable Fileable
Other-Scripted Scenario - Health Insurance Module			M. Scripted scenario health insurance.docx	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: 15,000

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	15,000	15,000
Annual IC Time Burden (Hours)	10,000	10,000
Annual IC Cost Burden (Dollars)	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.