OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Phase 2 Behavioral Survey

IC 218947 under ICR 202112-0920-002 · OMB 0920-1100.

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
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Phase 2 Behavioral Survey 0920-1100
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1100 Att 8a_Phase 2 Behavioral Survey (English) Att 8a_Phase 2 Behavioral Survey (English).docx Yes Yes Fillable Fileable
Form and Instruction 0920-1100 Att 8b_Phase 2 Behavioral Survey (Spanish) Att 8b_Phase 2 Behavioral Survey (Spanish).docx Yes Yes Fillable Fileable

Health Health Care Services

 

50 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 50 0 0 0 0 50
Annual IC Time Burden (Hours) 25 0 0 0 0 25
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att 12b_Screenshots_REDCaP_Phase 2 Behavioral Survey (Spanish) Att 12b_Screenshots_REDCaP_Phase 2 Behavioral Survey (Spanish).pdf 12/07/2021
Att 12a_Screenshots_REDCaP_Phase 2 Behavioral Survey Att 12a_Screenshots_REDCaP_Phase 2 Behavioral Survey.pdf 12/07/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.