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Instrument 12b: HPOG 2.0 National Evaluation Intermediate Follow-up COVID-19 Cohort Short-term Survey – Critical Items Only

IC 249732 under ICR 202212-0970-005 · OMB 0970-0462.

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Document Name
Document Type
Other-Survey
Other-Survey
Information Collection (IC) Details

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Instrument 12b: HPOG 2.0 National Evaluation Intermediate Follow-up COVID-19 Cohort Short-term Survey – Critical Items Only
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Survey Instrument 12b_COVID-19_CohortShortTermSurvey_Critical Items_Revised 12-9-21.docx Yes Yes Fillable Fileable

Community and Social Services Social Services

 

518 0
   
Individuals or Households
 
   0 %

  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 172 0 0 0 0 172
Annual IC Time Burden (Hours) 57 0 0 0 0 57
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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