Field Representative Exit Questionnaire/Decennial Field Staff Exit Questionnaire/Continuous Measurement Exit Questionnaire

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0404 can be found here:

Documents and Forms

Document Name Document Type
Form BC-1294(D) Field Representative Exit Questionnaire/Decennial Field Staff Exit Questionnaire/Continuous Measurement Exit Questionnaire Form
BC1294 Changes.doc Other-Proposed Changes to BC-1294
BC1294D changes.doc Other-Proposed Changes to BC-1294(D)
BC-1294(D) Decennial Field Staff Exit Questionnaire BC-1294(D).pdf Form
BC-1294(CM) Coverage Measurement Exit Questionnaire bc1294ccm.pdf Form
BC-1294 Field Representative Exit Questionnaire BC-1294.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Field Representative Exit Questionnaire/Decennial Field Staff Exit Questionnaire/Continuous Measurement Exit Questionnaire	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	Available Electronically?	Electronic Capability
Form	BC-1294(D)	Decennial Field Staff Exit Questionnaire	BC-1294(D).pdf	No	Paper Only
Form	BC-1294	Field Representative Exit Questionnaire	BC-1294.pdf	No	Paper Only
Other-Proposed Changes to BC-1294			BC1294 Changes.doc	No	Paper Only
Other-Proposed Changes to BC-1294(D)			BC1294D changes.doc	No	Paper Only
Form	BC-1294(CM)	Coverage Measurement Exit Questionnaire	bc1294ccm.pdf	No	Paper Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,500	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,500	500	1,355	645
Annual IC Time Burden (Hours)	393	83	226	84
Annual IC Cost Burden (Dollars)	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.