OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

ACASI Questionnaire

IC 218845 under ICR 201511-0925-001 · OMB 0925-0726.

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

View Information Collection (IC)

ACASI Questionnaire
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 2 Attachment 1 ACASI Questionnaire English Attach_1_ACASI_Questionnaire_English_9_2014_V_3.0-1.docx Yes Yes Fillable Fileable
Form and Instruction 4 Attachment 5 ACASI Questionnaire Portuguese Attach_5_ACASI_Questionnaire_Portuguese_10_14_V_2.0.docx Yes Yes Fillable Fileable

Health Health Care Services

 

275 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 275 0 275 0 0 0
Annual IC Time Burden (Hours) 183 0 183 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.