Information Collection

Self Response -Internet/Telephone/Paper

IC 227085 under ICR 201706-0607-001 · OMB 0607-0999.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0999 can be found here:

2018-11-30 - No material or nonsubstantive change to a currently approved collection
2018-03-08 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DH-1 2018 Census Test Questionnaire Self Response -Internet/Telephone/Paper	Form
Form DH-1(ES) 2018 Census Test- Questionnaire English/Spanish Self Response -Internet/Telephone/Paper	Form
1. 2017 ECaSE Internet Self Response Screen Shots.pdf	Other-Self-Response Instrument Scree
dh_9p_20170518.pdf	Other-Postcard
dh_9_p_es_20170518.pdf	Other-Postcard- English/Spanish
dh_9c_20170518.pdf	Other-Postcard
dh_9_c_es_20170518.pdf	Other-Postcard- English/Spanish
dh_9_20170508.pdf	Other-Postcard
dh_9_es_20170515.pdf	Other-Postcard
dh_5_es_20170505.pdf	Other-Envelope-English/Spanish
dh_6a_in_20170505.pdf	Other-Envelope
dh_6a_in_es_20170505.pdf	Other-Envelope-English/Spanish
dh_6b_in_es_20170505.pdf	Other-Envelope- English/Spanish
dh_6a_1_in_es_20170505.pdf	Other-Envelope-English/Spanish
dh_8a_20170512.pdf	Other-Envelope
dh_8a_es_20170512.pdf	Other-Envelope-English/Spanish
dh_16_l1_20170602_2.pdf	Other-Questionnaire Cover Letter
dh_16_l1_es_20170512.pdf	Other-Questionnaire Cover Letter-Eng
dh_16_l2_20170601.pdf	Other-Questionnaire Cover Letter
dh_16_l2_es_20170512.pdf	Other-Questionnaire Cover Letter-Eng
dh_16_l3_20170505.pdf	Other-Questionnaire Cover Letter
dh_16_l3_es_20170512.pdf	Other-Questionnaire Cover Letter-Eng
dh_16_l4_20170512.pdf	Other-Questionnaire Cover Letter
dh_16_l4_es_20170512.pdf	Other-Questionnaire Cover Letter-Eng
dh_17_l1_20170505.pdf	Other-Questionnaire Cover Letter
dh_17_l1_ES_20170509.pdf	Other-Questionnaire Cover Letter-Eng
dh_17_cqa_20170516.pdf	Other-Information Insert-Phone Numbe
dh_17i_es_20170602_2.pdf	Other-Information Insert-FAQs
DH_17I_ES_P1_06062017.pdf	Other-Information Insert-FAQs
2018 CT CQA Content Specification_061317.docx	Other-Census Quesionnaire Assistance
DH-1 2018 Census Test Questionnaire DH-1_051617.pdf	Form
DH-1(ES) 2018 Census Test- Questionnaire English/Spanish DH-1(ES)_051617.pdf	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Self Response -Internet/Telephone/Paper

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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-Questionnaire Cover Letter-English/Spanish			dh_16_l3_es_20170512.pdf		Yes	Yes	Fillable Fileable
Other-Questionnaire Cover Letter			dh_16_l4_20170512.pdf		Yes	Yes	Fillable Fileable
Other-Questionnaire Cover Letter-English/Spanish			dh_16_l4_es_20170512.pdf		Yes	Yes	Fillable Fileable
Other-Questionnaire Cover Letter			dh_17_l1_20170505.pdf		Yes	Yes	Fillable Fileable
Other-Questionnaire Cover Letter-English/Spanish			dh_17_l1_ES_20170509.pdf		Yes	Yes	Fillable Fileable
Other-Information Insert-Phone Numbers			dh_17_cqa_20170516.pdf		No		Fillable Fileable
Other-Information Insert-FAQs			dh_17i_es_20170602_2.pdf		Yes	Yes	Fillable Fileable
Other-Information Insert-FAQs			DH_17I_ES_P1_06062017.pdf		Yes	Yes	Fillable Fileable
Other-Self-Response Instrument Screenshots			1. 2017 ECaSE Internet Self Response Screen Shots.pdf		Yes	Yes	Fillable Fileable
Form	DH-1	2018 Census Test Questionnaire	DH-1_051617.pdf	survey.census.gov	Yes	Yes	Fillable Fileable
Form	DH-1(ES)	2018 Census Test- Questionnaire English/Spanish	DH-1(ES)_051617.pdf	survey.census.gov	Yes	Yes	Fillable Fileable
Other-Postcard			dh_9p_20170518.pdf		No		Paper Only
Other-Postcard- English/Spanish			dh_9_p_es_20170518.pdf		No		Paper Only
Other-Postcard			dh_9c_20170518.pdf		No		Paper Only
Other-Postcard- English/Spanish			dh_9_c_es_20170518.pdf		No		Paper Only
Other-Postcard			dh_9_20170508.pdf		No		Paper Only
Other-Postcard			dh_9_es_20170515.pdf		No		Paper Only
Other-Envelope-English/Spanish			dh_5_es_20170505.pdf		No		Paper Only
Other-Envelope			dh_6a_in_20170505.pdf		No		Paper Only
Other-Envelope-English/Spanish			dh_6a_in_es_20170505.pdf		No		Paper Only
Other-Envelope- English/Spanish			dh_6b_in_es_20170505.pdf		No		Paper Only
Other-Envelope-English/Spanish			dh_6a_1_in_es_20170505.pdf		No		Paper Only
Other-Envelope			dh_8a_20170512.pdf		No		Paper Only
Other-Envelope-English/Spanish			dh_8a_es_20170512.pdf		No		Paper Only
Other-Questionnaire Cover Letter			dh_16_l1_20170602_2.pdf		Yes	Yes	Fillable Fileable
Other-Questionnaire Cover Letter-English/Spanish			dh_16_l1_es_20170512.pdf		Yes	Yes	Fillable Fileable
Other-Questionnaire Cover Letter			dh_16_l2_20170601.pdf		Yes	Yes	Fillable Fileable
Other-Questionnaire Cover Letter-English/Spanish			dh_16_l2_es_20170512.pdf		Yes	Yes	Fillable Fileable
Other-Questionnaire Cover Letter			dh_16_l3_20170505.pdf		Yes	Yes	Fillable Fileable
Other-Census Quesionnaire Assistance Content Specificiation			2018 CT CQA Content Specification_061317.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 114,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 30 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	114,000	114,000
Annual IC Time Burden (Hours)	19,000	19,000
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.