Information Collection

High-Frequency Surveys Program/Household Pulse Survey Phase 4.1

IC 263027 under ICR 202402-0607-003 · OMB 0607-1029.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-1029 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Part A, Attachment High-Frequency Surveys Program/Household Pulse Survey Phase 4.1	Form
Part A, Attachment Part A, Attachment A_Phase 4.1 Questionnaire_v1 Part A, Attachment A_Phase 4.0 Questionnaire_11.20.23.docx	Form
Part A, Attachment Part A, Attachment A_Phase 4.1 Questionnaire_v3 Part A, Attachment A_Phase 4.1 Questionnaire_v3.docx	Form

IC Title:

High-Frequency Surveys Program/Household Pulse Survey Phase 4.1

Agency IC Tracking Number:

0607-1029

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Part A, Attachment A_Phase 4.1 Questionnaire_v3	Part A, Attachment A_Phase 4.1 Questionnaire_v3	Part A, Attachment A_Phase 4.1 Questionnaire_v3.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 264,600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	264,600	66,150	198,450
Annual IC Time Burden (Hours)	88,112	22,028	66,084
Annual IC Cost Burden (Dollars)	0	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.