Well Being

The Hispanic Community Health Study/ Study of Latinos (HCHS/SOL)(NHLBI)

Documents and Forms

Document Name Document Type
Form 1 Well Being Form and Instruction
1 Well Being WBE-Well Being-Eng.pdf Form and Instruction
WBS- Wellbeing-Span.pdf Well Being IC Document

Information Collection (IC) Details

IC Title:	Well Being	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	1	Well Being	WBE-Well Being-Eng.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13,878	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	13,878	13,878
Annual IC Time Burden (Hours)	925	925
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Well Being	WBS- Wellbeing-Span.pdf	06/19/2014

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