Information Collection

Survey - Incarcerated Respondents

IC 226225 under ICR 201703-0920-015 · OMB 0920-1206.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1206 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Survey - Incarcerated Respondents	Form
Survey Attachment E - Survey Instrument.docx	Form

IC Title:

Survey - Incarcerated Respondents

Agency IC Tracking Number:

Is this a Common Form? No

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
Form	none	Survey	Attachment E - Survey Instrument.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 105

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	105	105
Annual IC Time Burden (Hours)	131	131
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.