Document Name Document Type
Household Pulse Survey Form
Household Pulse Survey Questionnaire HH Pulse Survey Questionnaire_CLEAN FINAL_rev EDUC_041920.docx Form
Household Pulse Survey Questionnaire HH Pulse Survey Questionnaire_CLEAN FINAL_rev EDUC_041920.docx Form
Household Pulse Survey Questionnaire, Phase 3 Part A, ATTACH A_HH Pulse Questionnaire_Standard ICR_Phase 3_English_Spanish.pdf Form
Household Pulse Survey Questionnaire, Phase 3 Part A, ATTACH A_HH Pulse Questionnaire_Standard ICR_Phase 3_English_Spanish.pdf Form
Household Pulse Survey Questionnaire, Phase 3, Intent to Part A, ATTACH A_Household_Pulse_Survey_Phase3_Revised for Jan 6 2021.docx Form
Household Pulse Survey Questionnaire, Phase 3, Intent to Part A, ATTACH A_Household_Pulse_Survey_Phase3_Revised for Jan 6 2021.docx Form
Household Pulse Survey Questionnaire, Phase 3.1 Part A, ATTACH A_Phase 3.1 COVID-19 Household Pulse Survey Draft Questionnaire_012221.docx Form
Household Pulse Survey Questionnaire, Phase 3.1 Part A, ATTACH A_Phase 3.1 COVID-19 Household Pulse Survey Draft Questionnaire_012221.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Household Pulse Survey	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NA	Household Pulse Survey Questionnaire	HH Pulse Survey Questionnaire_CLEAN FINAL_rev EDUC_041920.docx	Yes	Yes	Fillable Fileable
Form	NA	Household Pulse Survey Questionnaire, Phase 3	Part A, ATTACH A_HH Pulse Questionnaire_Standard ICR_Phase 3_English_Spanish.pdf	Yes	Yes	Fillable Fileable
Form	NA	Household Pulse Survey Questionnaire, Phase 3, Intent to Vaccinate Update	Part A, ATTACH A_Household_Pulse_Survey_Phase3_Revised for Jan 6 2021.docx	Yes	Yes	Fillable Fileable
Form	NA	Household Pulse Survey Questionnaire, Phase 3.1	Part A, ATTACH A_Phase 3.1 COVID-19 Household Pulse Survey Draft Questionnaire_012221.docx	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,150,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,150,000	1,854,000	1,296,000
Annual IC Time Burden (Hours)	1,039,900	612,116	427,784
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.

Household Pulse Survey