Information Collection

Mobile Exam Center (MEC) Interview & Examination

IC 245120 under ICR 202205-0920-005 · OMB 0920-0950.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0950 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0950 Mobile Exam Center (MEC) Interview & Examination	Form and Instruction
0920-0950 MEC Interview & Exam Att_3a_Exam&Question Changes_201129.docx	Form and Instruction
0920-0950 MEC Interview & Exam Att_3a_Exam&Question Changes_201129.docx	Form and Instruction
0920-0950 MEC Interview & Examination 05APR2021 Att_3e_MEC Interview & Exam_revised 210323.docx	Form and Instruction
0920-0950 MEC Interview & Examination 05APR2021 Att_3e_MEC Interview & Exam_revised 210323.docx	Form and Instruction
MEC Interview and Exam (with Covid mods) Attachment 2a COQMEC_revision_211120 (clean).docx	Form and Instruction
MEC Interview and Exam (with Covid mods) Attachment 2a COQMEC_revision_211120 (clean).docx	Form and Instruction

IC Title:

Mobile Exam Center (MEC) Interview & Examination

Agency IC Tracking Number:

Is this a Common Form? No

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	0920-0950	MEC Interview & Exam	Att_3a_Exam&Question Changes_201129.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0950	MEC Interview & Examination 05APR2021	Att_3e_MEC Interview & Exam_revised 210323.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	MEC Interview and Exam (with Covid mods)	Attachment 2a COQMEC_revision_211120 (clean).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population

FR Citation: 49 FR 37693

Number of Respondents: 5,600

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	Previously Approved
Annual Number of Responses for this IC	5,600	5,600
Annual IC Time Burden (Hours)	14,000	14,000
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.