Household Survey (Telephone) for General Public and Consent

Public Health Systems, Mental Health and Community Recovery Project

Documents and Forms

Document Name Document Type
Household Survey (Telephone) for General Public and Consent Form
Household Survey and Consent Revised Attachment D_ Household Survey for General Public and Consent.docx Form

Information Collection (IC) Details

IC Title:	Household Survey (Telephone) for General Public and Consent	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	none	Household Survey and Consent	Revised Attachment D_ Household Survey for General Public and Consent.docx		Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Repair and Restore

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,440	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,440	3,440
Annual IC Time Burden (Hours)	1,433	1,433
Annual IC Cost Burden (Dollars)	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.