Information Collection

Cycle 3 Qx for Health Information National Trends Survey 4 (HINTS4)

IC 181323 under ICR 201303-0925-007 · OMB 0925-0538.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0538 can be found here:

Documents and Forms

Document Name Document Type
Form 3 Cycle 3 Qx for Health Information National Trends Survey 4 (HINTS4) Form and Instruction
3 List of Potential Question for Cycle 3 Qx Appendix B1 - List of Potential Items.pdf Form and Instruction
Appendix K - Cover Letters in English.docx Appendix K - Cover Letters in English IC Document
Appendix L - Letters in Spanish.docx Appendix L - Letters in Spanish IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Cycle 3 Qx for Health Information National Trends Survey 4 (HINTS4)	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3	List of Potential Question for Cycle 3 Qx	Appendix B1 - List of Potential Items.pdf		Yes	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: SORN #09-25-0156, "Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD,"	FR Citation: 67 FR 60743

Number of Respondents: 3,500	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	3,500	3,500
Annual IC Time Burden (Hours)	1,750	1,750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix K - Cover Letters in English	Appendix K - Cover Letters in English.docx	06/27/2011
Appendix L - Letters in Spanish	Appendix L - Letters in Spanish.docx	06/27/2011

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