Information Collection

MEC Exam and Interview Data Collection

IC 245120 under ICR 202603-0920-003 · OMB 0920-0950.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0950 MEC Examination and Interview Data Collection 17APR2025 MEC Exam and Interview Data Collection	Form and Instruction
0920-0950 MEC Examination and Interview Data Collection 17APR2025 0920-0950 Attachment_6g_MEC Exam and Interview Data Collection_2025APR16.docx	Form and Instruction
Attachment_11e_MEC_Examination_Materials_2024JULY16.pdf MEC Examination Materials	IC Document
Attachment_11f_MEC_Examination_Results_2024JULY16.pdf MEC Examination Results	IC Document

IC Title:

Agency IC Tracking Number:

0920-0950

Is this a Common Form? No

IC Status: Unchanged

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 and Instruction	0920-0950			N/A	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: 5,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	10,000	10,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
MEC Examination Materials		09/23/2024
MEC Examination Results		09/23/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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