Information Collection

Attachment 25: Paper/pen, CAWI or CATI for Spouses for AHS

IC 185933 under ICR 201302-0925-004 · OMB 0925-0406.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0406 can be found here:

Documents and Forms

Document Name Document Type
Form 12 Attachment 25: Paper/pen, CAWI or CATI for Spouses for AHS Form and Instruction
12 CAWI-CATI Attachment 25-3_CAWI_CATI_Ppt_Survey_Placeholder.docx Form and Instruction
10 CAWI Attachment 25-1_CAWI_Ppt_Intro.docx Form and Instruction
11 CATI Attachment 25-2_CATI_Ppt_Intro.doc Form and Instruction
13 Paper/Pen Attachment 25-4_Ppt_PaperPenSurvey.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Attachment 25: Paper/pen, CAWI or CATI for Spouses for AHS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	12	CAWI-CATI	Attachment 25-3_CAWI_CATI_Ppt_Survey_Placeholder.docx	Yes	Yes	Fillable Fileable
Form and Instruction	10	CAWI	Attachment 25-1_CAWI_Ppt_Intro.docx	Yes	Yes	Fillable Fileable
Form and Instruction	11	CATI	Attachment 25-2_CATI_Ppt_Intro.doc	No	No	Printable Only
Form and Instruction	13	Paper/Pen	Attachment 25-4_Ppt_PaperPenSurvey.docx	No	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: SORN #09-25-0200, Clinical, Epidemiologic, and Biometric Studies of the National Institutes of Health (NIH), HHS/NIH/ OD	FR Citation: 67 FR 60776

Number of Respondents: 10,201	Number of Respondents for Small Entity: 10,201

Affected Public: Private Sector	Private Sector: Farms

Percentage of Respondents Reporting Electronically: 33 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	10,201	10,051	150
Annual IC Time Burden (Hours)	4,250	4,237	13
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.