Information Collection

Household Interview

IC 245119 under ICR 202208-0920-009 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Household Interview	Form and Instruction
Form 0920-0950 Household Interview Household Interview	Form and Instruction
Form 0920-0950 Household Interview (with current Covid mods) Household Interview	Form and Instruction
Form 0920-0950 Household Interview (with current Rx mods) Household Interview	Form and Instruction
0920-0950 Household Interview Att_3c_HH Interview_201129.docx	Form and Instruction
0920-0950 Household Interview Att_3c_HH Interview_201129.docx	Form and Instruction
0920-0950 Household Interview (with current Covid mods) Att. 1a COQ_HH_220808_CLEAN COPY.docx	Form and Instruction
0920-0950 Household Interview (with current Covid mods) Att. 1a COQ_HH_220808_CLEAN COPY.docx	Form and Instruction
0920-0950 Household Interview (with current Rx mods) Att. 3a RXQ_COVID Med_220614_westat_NCHS_CLEAN COPY.docx	Form and Instruction
0920-0950 Household Interview (with current Rx mods) Att. 3a RXQ_COVID Med_220614_westat_NCHS_CLEAN COPY.docx	Form and Instruction

IC Title:

Household Interview

Agency IC Tracking Number:

0920-0950

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0950	Household Interview	Att_3c_HH Interview_201129.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0950	Household Interview (with current Covid mods)	Att. 1a COQ_HH_220808_CLEAN COPY.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0950	Household Interview (with current Rx mods)	Att. 3a RXQ_COVID Med_220614_westat_NCHS_CLEAN COPY.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
	Requested	Previously Approved
Annual Number of Responses for this IC	5,600	5,600
Annual IC Time Burden (Hours)	5,600	5,600
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.