Information Collection

HSOII Reference Period

IC 242921 under ICR 201708-1220-004 · OMB 1220-0141.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1220-0141 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment 1 HSOII Reference Period	Form and Instruction
Attachment 1 Initial Screener Questions Appendix 1 - Initial Screener.docx	Form and Instruction
Attachment 2 Main Survey Appendix 2 Main Survey.docx	Form and Instruction
Note to Reviewer - HSOII Reference Period_Final.DOCX Note to Reviewer - HSOII Reference Period	IC Document

IC Title:

HSOII Reference Period

Agency IC Tracking Number:

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 and Instruction	Attachment 1	Initial Screener Questions	Appendix 1 - Initial Screener.docx		Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 2	Main Survey	Appendix 2 Main Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,000

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	4,310	4,310
Annual IC Time Burden (Hours)	252	252
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Note to Reviewer - HSOII Reference Period	Note to Reviewer - HSOII Reference Period_Final.DOCX	09/08/2020

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