OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Health Care Access and Utilization

IC 211974 under ICR 201406-0925-002 · OMB 0925-0584.

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

View Information Collection (IC)

Health Care Access and Utilization
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 HCE-HealthCare-Eng HCE-HealthCare-Eng.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

13,878 0
   
Individuals or Households
 
   100 %

  Approved 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 13,878 0 13,878 0 0 0
Annual IC Time Burden (Hours) 3,470 0 3,470 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
HCS-HealthCare-Span HCS-health Care Questionnaire-Span.pdf 06/23/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.