Information Collection

Household Survey

IC 207086 under ICR 201305-1210-006 · OMB 1210-0151.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0151 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Survey Instrument 8-1-13.docx	Other-Survey Instrument
Survey Instrument Clarifications for OMB Reviewer 5-28-13.docx Survey Instrument Clarifications for OMB Reviewer	IC Document

IC Title:

Household Survey

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey Instrument			Survey Instrument 8-1-13.docx		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,900

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	2,900	2,900
Annual IC Time Burden (Hours)	870	870
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Survey Instrument Clarifications for OMB Reviewer	Survey Instrument Clarifications for OMB Reviewer 5-28-13.docx	05/28/2013

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