Information Collection

Race and Ethnicity Pilot Study

IC 261551 under ICR 202103-3045-003 · OMB 3045-0163.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3045-0163 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3045-0163 Race and Ethnicity Pilot Study	Form and Instruction
3045-0163 Race and Ethnicity Pilot Study Question Race and Ethnicity Pilot Question.docx Link will be sent to respondents by email	Form and Instruction
Census Pilot Memo_SUBMISSION TO OMB.docx Study Description and Briefing	IC Document

IC Title:

Race and Ethnicity Pilot Study

Agency IC Tracking Number:

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	3045-0163	Race and Ethnicity Pilot Study Question	Race and Ethnicity Pilot Question.docx	Link will be sent to respondents by email	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20,000

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	20,000	20,000
Annual IC Time Burden (Hours)	333	333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Study Description and Briefing	Census Pilot Memo_SUBMISSION TO OMB.docx	08/18/2023

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