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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
RANDS
Agency IC Tracking Number:
15BFA
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
Form
none
Telephone Screener
Appendix 3ab - Telephone Screeners-final.docx
Yes
Yes
Fillable Fileable
Form
none
Interview Questionnaire
Appendix 1 - Interviewer Administered Questionnaire rev.docx
No
Paper Only
Form
none
Web Intro Screen
Appendix 6 - Web Introduction Screen.docx
Yes
Yes
Fillable Fileable
Form
none
Respondent Demographic Data
Demographic Info.doc
No
Paper Only
Federal Enterprise Architecture Business Reference Module
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:
4,132
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
60 %
Approved
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
4,132
0
4,132
0
0
0
Annual IC Time Burden (Hours)
1,399
0
1,399
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Gallup Data Protection
Appendix 7 - Gallup Data Protection and Security Overview 2015.pdf
09/08/2015
Informed Consent
Appendix 4 - Informed Consent-final.docx
09/08/2015
Ad/Flyier
Appendix 2 - Cog Int Adv&flyer.docx
09/08/2015
Supporting Statement
OMB 10 Day Letter_RAND_0826 2015.docx
09/08/2015
Special Consent
Appendix 5 - Special Consent rev2.docx
09/18/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.