Information Collection

Flexible Consumer Behavior Survey Phone Follow-up

IC 218879 under ICR 202001-0920-015 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Flexible Consumer Behavior Survey Phone Follow-up	Form
Flexible Consumer Behavior Survey Att_3j_FCBS form 5_3_2018 082918.docx	Form
Att_3i_FCBS Deescription 072718.docx FCBS Description	IC Document
Att_3k_FCBS_Hand Cards 072718.docx FCBS Hand Cards	IC Document

IC Title:

Flexible Consumer Behavior Survey Phone Follow-up

Agency IC Tracking Number:

0920-0950

Is this a Common Form? No

IC Status: Unchanged

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	Flexible Consumer Behavior Survey	Att_3j_FCBS form 5_3_2018 082918.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0167 Health Resources Utilization Statistics

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
	Requested	Previously Approved
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	1,667	1,667
Annual IC Cost Burden (Dollars)	39,350	39,350

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
FCBS Description	Att_3i_FCBS Deescription 072718.docx	09/13/2018
FCBS Hand Cards	Att_3k_FCBS_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.