OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Vital Signs Survey

IC 207398 under ICR 201402-0920-015 · OMB 0920-0956.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Vital Signs Survey
 
Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None Vital Signs Survey VS_screenshots.docx Yes Yes Fillable Fileable
Form and Instruction None Vital Signs Survey Vital Signs Surveyv2.docx Yes Yes Printable Only

Health Health Care Services

 

3,000 0
   
Individuals or Households
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 3,000 0 0 0 0 3,000
Annual IC Time Burden (Hours) 351 0 0 0 0 351
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Survey1template _VitalSignsv2 Survey1template _VitalSignsv2.docx 06/11/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.