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Federal forms, ICRs, and supporting documents

Information Collection

2017 Census Test - Self Response

IC 224066 under ICR 201609-0607-002 · OMB 0607-0996.

Documents and Forms
Document Name
Document Type
Form
Other-Questionnaire Cover Letter
Other-Questionnaire Cover Letter
Other-Questionnaire Cover Letter
Other-Questionnaire Cover Letter
Other-Questionnaire Cover Letter
Other-Questionnaire Cover Letter
Other-Questionnaire Cover Letter
Other-Questionnaire Cover Letter
Other-Postcard
Other-Postcard
Other-Postcard
Other-Postcard
Other-Postcard
Other-Postcard
Other-Information Insert
Other-Envelope
Other-Envelope
Other-Envelope
Other-Envelope
Other-Envelope
Other-Questionnaire Cover Letter
Other-Questionnaire Cover Letter
Other-Information Insert
Other-Specification: Internet Instru
Other-Specification: Interent Help T
Other-Specification: CQA Internet In
Form
Form
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

2017 Census Test - Self Response
 
No New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form DG-1D English paper questionnaire DG-1D_092016.pdf survey.census.gov Yes Yes Fillable Fileable
Form DG-1D(E/S) English/Spanish paper questionnaire DG-1D(ES)_092016.pdf survey.census.gov Yes Yes Fillable Fileable
Other-Questionnaire Cover Letter dg_16_l1_es_20160901.pdf No   Paper Only
Other-Questionnaire Cover Letter dg_16_l2_es_20160928.pdf No   Paper Only
Other-Questionnaire Cover Letter dg_16_l3_20160901.pdf No   Paper Only
Other-Questionnaire Cover Letter dg_16_l3_es_20160928.pdf No   Paper Only
Other-Questionnaire Cover Letter dg_16_l4_20160901.pdf No   Paper Only
Other-Questionnaire Cover Letter dg_16_l4_es_20160928.pdf No   Paper Only
Other-Questionnaire Cover Letter dg_17_l1_20160927.pdf No   Paper Only
Other-Questionnaire Cover Letter dg_17_l1_es_20160928.pdf No   Paper Only
Other-Postcard dg9_c_20160825.pdf No   Paper Only
Other-Postcard dg_9_c_es_20160908.pdf No   Paper Only
Other-Postcard dg9_p_20160908.pdf No   Paper Only
Other-Postcard dg_9_p_es_20160825.pdf No   Paper Only
Other-Postcard dg9_20160908.pdf No   Paper Only
Other-Postcard dg_9_es_20160825.pdf No   Paper Only
Other-Information Insert dg_17_cqa_20160928.pdf No   Paper Only
Other-Envelope dg_5_es_20160818.pdf No   Paper Only
Other-Envelope dg_6a_1_in_es_20160901.pdf No   Paper Only
Other-Envelope dg_6a_in_es_20160818.pdf No   Paper Only
Other-Envelope dg_6b_in_es_20160818.pdf No   Paper Only
Other-Envelope dg_8a_es_20160927.pdf No   Paper Only
Other-Questionnaire Cover Letter dg_16_l1_20161003.pdf No   Paper Only
Other-Questionnaire Cover Letter dg_16_l2_20161003.pdf No   Paper Only
Other-Information Insert dg_17i_es_20161003.pdf No   Paper Only
Other-Specification: Internet Instrument 2017 CT ISR Baseline Specification 10242016.docx survey.census.gov Yes Yes Fillable Fileable
Other-Specification: Interent Help Text 2017 CT Internet Spec-Help Text-Appendix B 10242016.docx survey.census.gov Yes Yes Fillable Fileable
Other-Specification: CQA Internet Instrument 2017 CT ISR CQA Specification 10242016.docx survey.census.gov Yes Yes Fillable Fileable

General Government Central Records & Statistical Mgt

 

36,000 0
   
Individuals or Households
 
   50 %

  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 36,000 0 36,000 0 0 0
Annual IC Time Burden (Hours) 6,000 0 6,000 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
2017 Census Test Contact Strategy 2017 CT Panel Design Matrix.docx 10/24/2016
2017 Census Test- Index of Forms 2017 Census Test - Index of Forms_20161017 - national sample only.docx 10/24/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.