Information Collection

Panel Replenishment Household Screening Respondent

IC 216700 under ICR 202004-0910-008 · OMB 0910-0815.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment_1_Questionnaires_English_CLEAN_042220.pdf	Other-Questionnaires - English
Attachment_2_Questionnaires_Spanish_CLEAN_042220.pdf	Other-Questionnaires - Spanish

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Other-Questionnaires - English					Yes	Yes	Fillable Fileable
Other-Questionnaires - Spanish					Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 38,280

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	12,632	12,632
Annual IC Time Burden (Hours)	1,642	1,642
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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