Information Collection

Household survey

IC 260979 under ICR 202307-1028-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
resident questionnaire draft 080723.docx	Other-survey
Madajewicz consent script for survey 073123.pdf	Other-informed consent

IC Title:

Household survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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
Other-survey			resident questionnaire draft 080723.docx		Yes	Yes	Fillable Printable
Other-informed consent			Madajewicz consent script for survey 073123.pdf		Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	150	150
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.