Information Collection

Comparing Health Insurance Measurement Error (CHIME)

IC 216428 under ICR 201505-0607-002 · OMB 0607-0983.

Documents and Forms

Document Name Document Type
chime questionnaire FINAL.doc Other-CHIME March 2015 Draft Questio

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Comparing Health Insurance Measurement Error (CHIME)	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
Other-CHIME March 2015 Draft Questionnaire			chime questionnaire FINAL.doc		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,000	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	5,000	5,000
Annual IC Time Burden (Hours)	1,083	1,083
Annual IC Cost Burden (Dollars)	0	0

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.