Information Collection

2014 Heritage Health Index survey questionnaire

IC 211214 under ICR 201404-3137-001 · OMB 3137-0088.

Documents and Forms

Document Name Document Type
Form HHI 2014 Form 1 2014 Heritage Health Index survey questionnaire Form and Instruction
HHI 2014 Form 1 HHI 2014 Collection Questoinnaire IMLS HHI 2014 Collection Questionnaire Paper 2014-09-05.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	2014 Heritage Health Index survey questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	HHI 2014 Form 1	HHI 2014 Collection Questoinnaire	IMLS HHI 2014 Collection Questionnaire Paper 2014-09-05.docx		Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Cultural and Historic Preservation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,979	Number of Respondents for Small Entity: 3,959

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,979	4,979
Annual IC Time Burden (Hours)	5,507	5,507
Annual IC Cost Burden (Dollars)	137,620	137,620

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.