PART A, ATTACH A_CHP Screener, Baseline, and Topical Questionnaires_v2

Census Household Panel Topical 2 and 3

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-1025 can be found here:

Documents and Forms

Document Name Document Type
Form Part A, Attachment PART A, ATTACH A_CHP Screener, Baseline, and Topical Questionnaires_v2 Form
Part A, Attachment Part A, Attachment A_CHP Topical 2 and 3 Questionnaire_v Part A, Attachment A_CHP Topical 2 and 3 Questionnaire_v3.docx Form
Part A, Attachment Part A, Attachment A_CHP Topical 2 and 3 Questionnaire Part A, Attachment A_CHP Topical 2 and 3 Questionnaire_v5.docx Form

Information Collection (IC) Details

IC Title:	PART A, ATTACH A_CHP Screener, Baseline, and Topical Questionnaires_v2	Agency IC Tracking Number:

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	Part A, Attachment A_CHP Topical 2 and 3	Part A, Attachment A_CHP Topical 2 and 3 Questionnaire	Part A, Attachment A_CHP Topical 2 and 3 Questionnaire_v5.docx		Yes	Yes	Fillable Fileable

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 132,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	132,000	-85,500	217,500
Annual IC Time Burden (Hours)	43,956	-28,472	72,428
Annual IC Cost Burden (Dollars)	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.