Information Collection

Labor Force Module of Persons with Disabilities Round 2

IC 223623 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⚠️ Notice: This information collection may be referencing outdated material.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 - Attach 3 Telephone Screener rev.docx	Other-WORD
Labor Force - Attach 5 Resp Data Collect Sheet.docx	Other-WORD
Labor Force - Attach 4 Informed Consent.docx	Other-WORD
1 Questionnaire Labor Force - Attach 1 Qnne 0826 2016 (1) V2.docx	Form and Instruction
Labor Force -10day letter 092116.docx Request for Approval	IC Document
Labor Force - Attach 2a-c Ads&Flyers.docx Att 2a _ Labor Force Module	IC Document
Labor Force - Attach 6 Thank You Letter.docx Att 6_Thank You Letter	IC Document
Labor Force - Attach 7 Special Consent.docx Att 7_Special Consent for Expanded Use	IC Document

IC Title:

Labor Force Module of Persons with Disabilities Round 2

Agency IC Tracking Number:

16BEU

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Labor Force - Attach 3 Telephone Screener rev.docx	Yes	Yes	Paper Only
Other-WORD			Labor Force - Attach 5 Resp Data Collect Sheet.docx	Yes	Yes	Fillable Fileable
Other-WORD			Labor Force - Attach 4 Informed Consent.docx	Yes	Yes	Paper Only
Form and Instruction	1	Questionnaire	Labor Force - Attach 1 Qnne 0826 2016 (1) V2.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Health and Demographic Surveys Conducted in Probability Samples of the US 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
Request for Approval	Labor Force -10day letter 092116.docx	09/21/2016
Att 2a _ Labor Force Module	Labor Force - Attach 2a-c Ads&Flyers.docx	09/21/2016
Att 6_Thank You Letter	Labor Force - Attach 6 Thank You Letter.docx	09/21/2016
Att 7_Special Consent for Expanded Use	Labor Force - Attach 7 Special Consent.docx	09/21/2016

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