OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Main Questionnaire

IC 245433 under ICR 202101-0920-015 · OMB 0920-1327.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Main Questionnaire 0920-20QJ
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-20QJ Web Questionnaire Developer Logic Attachment 3a - Web questionnaire specifications.docx Yes Yes Fillable Fileable
Form and Instruction 0920-20QJ Self-Administered Hardcopy Questionnaire Attachment 3b_Self administered hardcopy questionnaire.pdf No   Fillable Fileable

Health Public Health Monitoring

 

2,650 0
   
State, Local, and Tribal Governments
 
   90 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,650 0 2,650 0 0 0
Annual IC Time Burden (Hours) 1,325 0 1,325 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Main Questionnaire Screenshots Attachment 9_Web questionnaire screenshots.pdf 01/26/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.