Information Collection

Mobile Exam Center Interview and Exam

IC 233001 under ICR 201809-0920-002 · OMB 0920-0950.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0950 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Mobile Exam Center Interview and Exam	Form
MEC Questionnaire and Exam Att_3f_MEC Questionnaire Exam 081718.docx	Form
Att_3g_MEC-CAPI DRQ_ Hand Cards 072718.docx MEC Hand Cards	IC Document

IC Title:

Mobile Exam Center Interview and Exam

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	MEC Questionnaire and Exam	Att_3f_MEC Questionnaire Exam 081718.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 Probablity Samples of the US Population

FR Citation: 49 FR 37693

Number of Respondents: 5,000

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	5,000	5,000
Annual IC Time Burden (Hours)	20,000	20,000
Annual IC Cost Burden (Dollars)	477,200	477,200

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
MEC Hand Cards	Att_3g_MEC-CAPI DRQ_ Hand Cards 072718.docx	09/13/2018

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