Information Collection

MEPS-HC Validation Interview

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

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 and Instruction	53b				Yes	Yes	Fillable Fileable
Form and Instruction	53a				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 %

table that charts list of burden
	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

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.

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