Information Collection

Mobile Exam Center (MEC) Interview & Examination

IC 245120 under ICR 202302-0920-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 0920-0950 Mobile Exam Center (MEC) Interview & Examination Form and Instruction
0920-0950 MEC Interview & Examination Att_3e_MEC Interview & Exam_revised_2022OCT13.docx Form and Instruction
0920-0950 MEC Interview & Examination Att_3e_MEC Interview & Exam_revised_2022OCT13.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Mobile Exam Center (MEC) Interview & Examination	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 & Examination	Att_3e_MEC Interview & Exam_revised_2022OCT13.docx	NA	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 %

	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

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.