Information Collection

RANDS (Round 3) during COVID-19

IC 245515 under ICR 202102-0920-004 · OMB 0920-1323.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
RANDS (Round 3) during COVID-19	Form and Instruction
Web Questionnaire Introduction Screen / Telephone Interv Att B - Intro Screen and Questionnaire_01 28 2021.docx	Form and Instruction
Web Questionnaire Introduction Screen / Telephone Interv Att B - Intro Screen and Questionnaire_01 28 2021.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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 and Instruction	NA	Web Questionnaire Introduction Screen / Telephone Interview Introduction / RANDS during COVID-19 Questionnaire	Att B - Intro Screen and Questionnaire_01 28 2021.docx	N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0167 Health Resources Utilization Statistics

FR Citation: 49 FR 37693

Number of Respondents: 5,200

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,200	5,200
Annual IC Time Burden (Hours)	1,733	1,733
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.