View Information Collection (IC)

View Information Collection (IC)

IC Title:	20152 CHIME-Comparing Health Insurance Measurement Error	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Other-Invitation to participate			advanceletter_MedicaFinal_v2 (4-8-15).pdf		Yes	Yes	Paper Only
Other-CHIME March 2015 Draft Questionnaire			chime questionnaire FINAL.doc		Yes	Yes	Paper Only
Other-CHIME March 2015 Draft Questionnaire			chime questionnaire v9.doc		Yes	Yes	Paper Only
Other-Attachment A			white_paper_v8.doc		Yes	Yes	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,000	Number of Respondents for Small Entity: 5,000

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	5,000	0	5,000	0	0	0
Annual IC Time Burden (Hours)	1,083	0	1,083	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	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.