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Senior Comparion Program Demonstration Project Impact Evaluation Questionnaires
SENIOR COMPARION PROGRAM DEMONSTRATION PROJECT IMPACT EVALUATION QUESTIONNAIRES
OMB: 3001-0020
IC ID: 148448
OMB.report
ACTION
OMB 3001-0020
ICR 198001-3001-001
IC 148448
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3001-0020 can be found here:
1980-05-27 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
SENIOR COMPARION PROGRAM DEMONSTRATION PROJECT IMPACT EVALUATION QUESTIONNAIRES
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
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
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,961
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
1,961
0
0
811
0
1,150
Annual IC Time Burden (Hours)
1,394
0
0
544
0
850
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.