Information Collection

2014 Heritage Health Index survey questionnaire

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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
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 %

table that charts list of burden
	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

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.