Information Collection

Household questionnaire (NO SCREENER)

IC 232739 under ICR 201812-0970-006 · OMB 0970-0391.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0391 can be found here:

Documents and Forms

Document Name Document Type
15a_2019 NSECE Household Screener and Questionnaire (clean copy).docx Other-Screener and Questionnaire
15a_2019 NSECE Household Screener and Questionnaire (tracking copy).docx Revised Household Screener and Questionnaire - Tracked Version - Nonsub Change Req Dec 2018 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Household questionnaire (NO SCREENER)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screener and Questionnaire			15a_2019 NSECE Household Screener and Questionnaire (clean copy).docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	10,600	10,600
Annual IC Time Burden (Hours)	10,600	10,600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Revised Household Screener and Questionnaire - Tracked Version - Nonsub Change Req Dec 2018	15a_2019 NSECE Household Screener and Questionnaire (tracking copy).docx	12/06/2018

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