View Information Collection (IC)

View Information Collection (IC)

Household Screener Instrument
No Modified

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction none Household Screener ATT_I-ScreenerQuestionnaire040918.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population  49 FR 37693

15,000 0
Individuals or Households
   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 15,000 0 0 0 0 15,000
Annual IC Time Burden (Hours) 750 0 0 0 0 750
Annual IC Cost Burden (Dollars) 19,650 0 19,650 0 0 0

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