Information Collection

Labor Force Module of Persons with Disabilities

IC 219178 under ICR 201506-0920-003 · OMB 0920-0222.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Labor Force - Appendix 3 Telephone Screener.docx	Other-Telephone Screener
Labor Force - Appendix 1 Qnne 120215.docx	Other-Telephone Questionnaire
Labor Force - Appendix 2a-c Ads&Flyers.docx Ads & Flyers	IC Document
Labor Force - Appendix 4 Informed Consent.docx Informed Consent	IC Document
Labor Force - Appendix 5 Special Consent.docx Special Consent	IC Document
Labor Force -10day letter 120215.docx 10-day Letter Request	IC Document

IC Title:

Labor Force Module of Persons with Disabilities

Agency IC Tracking Number:

16GI

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
Other-Telephone Screener			Labor Force - Appendix 3 Telephone Screener.docx		Yes	Yes	Fillable Printable
Other-Telephone Questionnaire			Labor Force - Appendix 1 Qnne 120215.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population

FR Citation: 49 FR 37693

Number of Respondents: 68

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	68	68
Annual IC Time Burden (Hours)	24	24
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Ads & Flyers	Labor Force - Appendix 2a-c Ads&Flyers.docx	12/06/2015
Informed Consent	Labor Force - Appendix 4 Informed Consent.docx	12/06/2015
Special Consent	Labor Force - Appendix 5 Special Consent.docx	12/06/2015
10-day Letter Request	Labor Force -10day letter 120215.docx	12/06/2015

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