Information Collection

Nonresponse Survey

IC 248418 under ICR 202203-0920-002 · OMB 0920-1359.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1359 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-21DC Nonresponse Survey	Form and Instruction
0920-21DC Nonresponse Survey Attachment 6_Nonresponse Survey Item.docx	Form and Instruction
0920-21DC Nonresponse Survey Attachment 6_Nonresponse Survey Item.docx	Form and Instruction

IC Title:

Nonresponse Survey

Agency IC Tracking Number:

0920-21DC

Is this a Common Form? Yes

IC Status: Unchanged

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	0920-21DC	Nonresponse Survey	Attachment 6_Nonresponse Survey Item.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 480

Number of Respondents for Small Entity: 300

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	480	480
Annual IC Time Burden (Hours)	16	16
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.