Information Collection

Attachment 26: Paper/pen, CAWI, and CATI for Proxy for AHS

IC 205828 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 14 Attachment 26: Paper/pen, CAWI, and CATI for Proxy for AHS	Form and Instruction
15 CATI Proxy Attachment 26-2_Proxy_CATI_Intro.doc	Form and Instruction
16 CAWI-CATI Proxy Attachment 26-3_CAWI_Proxy_Survey.docx	Form and Instruction
17 Paper-Pen Proxy Attachment 26-4_Proxy_PaperPenSurvey.docx	Form and Instruction
14 CAWI Proxy Attachment 26-1_Proxy_CAWI_Intro_Interview_Script.pdf	Form and Instruction

IC Title:

Attachment 26: Paper/pen, CAWI, and CATI for Proxy for AHS

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 and Instruction	14	CAWI Proxy	Attachment 26-1_Proxy_CAWI_Intro_Interview_Script.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	15	CATI Proxy	Attachment 26-2_Proxy_CATI_Intro.doc	No	No	Printable Only
Form and Instruction	16	CAWI-CATI Proxy	Attachment 26-3_CAWI_Proxy_Survey.docx	Yes	Yes	Fillable Fileable
Form and Instruction	17	Paper-Pen Proxy	Attachment 26-4_Proxy_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: 635

Number of Respondents for Small Entity: 635

Affected Public: Private Sector

Private Sector: Farms

Percentage of Respondents Reporting Electronically: 33 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	635	635
Annual IC Time Burden (Hours)	159	159
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.