OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Survey of Health Insurance and Program Participation

IC 192033 under ICR 201002-0607-003 · OMB 0607-0959.

Documents and Forms
Document Name
Document Type
Form
Other-Advance Letter
Other-ACS & CPS state-specific plan
Other-CPS state-specific plan names
Other-TANF names
Form
Information Collection (IC) Details

View Information Collection (IC)

Survey of Health Insurance and Program Participation
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SHIPP Questionnaire (CATI Specifications) SHIPP Questionnaire (CATI Specifications) omb qnnaire.doc Yes Yes Fillable Fileable
Other-Advance Letter OMB advance letter.wpd No   Paper Only
Other-ACS & CPS state-specific plan names SHIPP ACS & EXP state-specific plan names.doc Yes Yes Fillable Fileable
Other-CPS state-specific plan names SHIPP CPS state-specific plan names.xls Yes Yes Fillable Fileable
Other-TANF names TANF names.rtf Yes Yes Fillable Fileable

General Government Central Records & Statistical Mgt

 

5,000 0
   
Individuals or Households
 
   0 %

  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 5,000 0 5,000 0 0 0
Annual IC Time Burden (Hours) 1,000 0 1,000 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.