High-Frequency Surveys Program/Household Pulse Survey Phase 4.2

Documents and Forms

Document Name Document Type
Form Part A, Attachment High-Frequency Surveys Program/Household Pulse Survey Phase 4.2 Form
Part A, Attachment Part A, Attachment A_Phase 4.2 Questionnaire_rev4 Part A, Attachment A_Phase 4.2 Questionnaire_rev4.docx Form
Part A, Attachment Part A, Attachment A_Phase 4.2 Questionnaire_rev4 Part A, Attachment A_Phase 4.2 Questionnaire_rev4.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	High-Frequency Surveys Program/Household Pulse Survey Phase 4.2	Agency IC Tracking Number:	0607-1029

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	Part A, Attachment A_Phase 4.2 Questionnaire_rev4	Part A, Attachment A_Phase 4.2 Questionnaire_rev4	Part A, Attachment A_Phase 4.2 Questionnaire_rev4.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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	264,600	264,600
Annual IC Time Burden (Hours)	88,112	88,112
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.