Information Collection

Household Interview

IC 213574 under ICR 202002-0920-011 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Household Interview	Form
Household Interview Att_3d_HH SP Family Instruments 10_23_18.docx	Form
Att_3e_HH SP Family_Hand Cards 081718.docx Household Interview Hand Cards	IC Document

IC Title:

Household Interview

Agency IC Tracking Number:

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	Household Interview	Att_3d_HH SP Family Instruments 10_23_18.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 Probability 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	Previously Approved
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	7,500	7,500
Annual IC Cost Burden (Dollars)	178,950	178,950

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Household Interview Hand Cards	Att_3e_HH SP Family_Hand Cards 081718.docx	09/13/2018

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