View Information Collection (IC)

View Information Collection (IC)

IC Title:	Interviews Observation Form (Screener Verification)	Agency IC Tracking Number:	0920-0314

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	0920-0314	INTERVIEW OBSERVATION FORM	ATT-L-InterviewObsForm_revJun2021.docx		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: 250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	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	250	0	-1,100	0	0	1,350
Annual IC Time Burden (Hours)	8	0	-37	0	0	45
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
In-person Interview Verification Procedures and Questionnaires for Screener Survey and Main Survey	ATT-K-NSFG-VerificationProcedures.docx	07/28/2023

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