Information Collection

Self Response -Internet/Telephone/Paper

IC 227085 under ICR 201801-0607-002 · OMB 0607-0999.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0999 can be found here:

2018-11-30 - No material or nonsubstantive change to a currently approved collection
2018-03-08 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Document Name Document Type
1. 2017 ECaSE Internet Self Response Screen Shots.pdf Other-Self-Response Instrument Scree
dh_9p_20170518.pdf Other-Postcard
dh_9_p_es_20170518.pdf Other-Postcard- English/Spanish
dh_9c_20170518.pdf Other-Postcard
dh_9_c_es_20170518.pdf Other-Postcard- English/Spanish
dh_9_20170508.pdf Other-Postcard
dh_9_es_20170515.pdf Other-Postcard
dh_5_es_20170505.pdf Other-Envelope-English/Spanish
dh_6a_in_20170505.pdf Other-Envelope
dh_6a_in_es_20170505.pdf Other-Envelope-English/Spanish
dh_6b_in_es_20170505.pdf Other-Envelope- English/Spanish
dh_6a_1_in_es_20170505.pdf Other-Envelope-English/Spanish
dh_8a_20170512.pdf Other-Envelope
dh_8a_es_20170512.pdf Other-Envelope-English/Spanish
dh_16_l1_20170602_2.pdf Other-Questionnaire Cover Letter
dh_16_l1_es_20170512.pdf Other-Questionnaire Cover Letter-Eng
dh_16_l2_20170601.pdf Other-Questionnaire Cover Letter
dh_16_l2_es_20170512.pdf Other-Questionnaire Cover Letter-Eng
dh_16_l3_20170505.pdf Other-Questionnaire Cover Letter
dh_16_l3_es_20170512.pdf Other-Questionnaire Cover Letter-Eng
dh_16_l4_20170512.pdf Other-Questionnaire Cover Letter
dh_16_l4_es_20170512.pdf Other-Questionnaire Cover Letter-Eng
dh_17_l1_20170505.pdf Other-Questionnaire Cover Letter
dh_17_l1_ES_20170509.pdf Other-Questionnaire Cover Letter-Eng
dh_17_cqa_20170516.pdf Other-Information Insert-Phone Numbe
dh_17i_es_20170602_2.pdf Other-Information Insert-FAQs
DH_17I_ES_P1_06062017.pdf Other-Information Insert-FAQs
2018 CT CQA Content Specification_061317.docx Other-Census Quesionnaire Assistance
DH-1 2018 Census Test Questionnaire DH-1_051617.pdf survey.census.gov Form
DH-1(ES) 2018 Census Test- Questionnaire English/Spanish DH-1(ES)_051617.pdf survey.census.gov Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Self Response -Internet/Telephone/Paper	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Census Quesionnaire Assistance Content Specificiation			2018 CT CQA Content Specification_061317.docx		Yes	Yes	Fillable Fileable
Other-Self-Response Instrument Screenshots			1. 2017 ECaSE Internet Self Response Screen Shots.pdf		Yes	Yes	Fillable Fileable
Form	DH-1	2018 Census Test Questionnaire	DH-1_051617.pdf	survey.census.gov	Yes	Yes	Fillable Fileable
Form	DH-1(ES)	2018 Census Test- Questionnaire English/Spanish	DH-1(ES)_051617.pdf	survey.census.gov	Yes	Yes	Fillable Fileable
Other-Postcard			dh_9p_20170518.pdf		No		Paper Only
Other-Postcard- English/Spanish			dh_9_p_es_20170518.pdf		No		Paper Only
Other-Postcard			dh_9c_20170518.pdf		No		Paper Only
Other-Postcard- English/Spanish			dh_9_c_es_20170518.pdf		No		Paper Only
Other-Postcard			dh_9_20170508.pdf		No		Paper Only
Other-Postcard			dh_9_es_20170515.pdf		No		Paper Only
Other-Envelope-English/Spanish			dh_5_es_20170505.pdf		No		Paper Only
Other-Envelope			dh_6a_in_20170505.pdf		No		Paper Only
Other-Envelope-English/Spanish			dh_6a_in_es_20170505.pdf		No		Paper Only
Other-Envelope- English/Spanish			dh_6b_in_es_20170505.pdf		No		Paper Only
Other-Envelope-English/Spanish			dh_6a_1_in_es_20170505.pdf		No		Paper Only
Other-Envelope			dh_8a_20170512.pdf		No		Paper Only
Other-Envelope-English/Spanish			dh_8a_es_20170512.pdf		No		Paper Only
Other-Questionnaire Cover Letter			dh_16_l1_20170602_2.pdf		Yes	Yes	Fillable Fileable
Other-Questionnaire Cover Letter-English/Spanish			dh_16_l1_es_20170512.pdf		Yes	Yes	Fillable Fileable
Other-Questionnaire Cover Letter			dh_16_l2_20170601.pdf		Yes	Yes	Fillable Fileable
Other-Questionnaire Cover Letter-English/Spanish			dh_16_l2_es_20170512.pdf		Yes	Yes	Fillable Fileable
Other-Questionnaire Cover Letter			dh_16_l3_20170505.pdf		Yes	Yes	Fillable Fileable
Other-Questionnaire Cover Letter-English/Spanish			dh_16_l3_es_20170512.pdf		Yes	Yes	Fillable Fileable
Other-Questionnaire Cover Letter			dh_16_l4_20170512.pdf		Yes	Yes	Fillable Fileable
Other-Questionnaire Cover Letter-English/Spanish			dh_16_l4_es_20170512.pdf		Yes	Yes	Fillable Fileable
Other-Questionnaire Cover Letter			dh_17_l1_20170505.pdf		Yes	Yes	Fillable Fileable
Other-Questionnaire Cover Letter-English/Spanish			dh_17_l1_ES_20170509.pdf		Yes	Yes	Fillable Fileable
Other-Information Insert-Phone Numbers			dh_17_cqa_20170516.pdf		No		Fillable Fileable
Other-Information Insert-FAQs			dh_17i_es_20170602_2.pdf		Yes	Yes	Fillable Fileable
Other-Information Insert-FAQs			DH_17I_ES_P1_06062017.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 114,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 30 %

	Approved	Previously Approved
Annual Number of Responses for this IC	114,000	114,000
Annual IC Time Burden (Hours)	19,000	19,000
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.