OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Monthly Outcome Survey (MOS)

IC 245272 under ICR 202101-0990-001 · OMB 0990-0475.

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

View Information Collection (IC)

Monthly Outcome Survey (MOS)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Attachment D Attachment D: COVID-19 Monthly Outcome Survey – Questionnaire Part A_Attachment D_COVID-19 Monthly Outcome Survey_Questionnaire.docx Yes Yes Fillable Fileable
Form and Instruction Attachment E Attachment E: COVID-19 Monthly Outcome Survey – Ipsos Omnibus COVID Questions Part A_Attachment E_COVID-19 Monthly Outcome Survey_Ipsos Omnibus COVID Questions.docx Yes Yes Fillable Fileable
Form and Instruction Attachment F Attachment F: COVID-19 Monthly Outcome Survey – Consent Form Part A_Attachment F_COVID-19 Monthly Outcome Survey_Ipsos Consent Form.docx Yes Yes Fillable Fileable
Form and Instruction Attachment G Attachment G: COVID-19 Monthly Outcome Survey – Communications Part A_Attachment G_COVID-19 Monthly Outcome Survey_Communications.docx Yes Yes Fillable Fileable

Health Health Care Services

 

5,000 0
   
Individuals or Households
 
   100 %

  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 60,000 0 60,000 0 0 0
Annual IC Time Burden (Hours) 10,200 0 10,200 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.