Information Collection

MEPS-HC Validation Interview

IC 204199 under ICR 202603-0935-001 · OMB 0935-0118.

Documents and Forms

Document Name Document Type
Form 53b Phone Validation Form MEPS-HC Validation Interview Form and Instruction
Form 53a Validation Letter MEPS-HC Validation Interview Form and Instruction
53b Phone Validation Form Attachment 53b -- Phone Validation Form.pdf Form and Instruction
53a Validation Letter Attachment 53a -- Validation Letter.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	MEPS-HC Validation Interview	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	53b	Phone Validation Form	Attachment 53b -- Phone Validation Form.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	53a	Validation Letter	Attachment 53a -- Validation Letter.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,491	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,491	-335	1,826
Annual IC Time Burden (Hours)	124	-28	152
Annual IC Cost Burden (Dollars)	8,100	8,100	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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].