The survey is
being conducted seperately, in order to achieve more standardized
administration. Therefore, this clearance is for the annual report
only. The survey must be submitted under a seperate OMB number. At
that time, OMB shall determine if questions on the annual report
and the survey are unnecessarily duplicative.
Inventory as of this Action
Requested
Previously Approved
03/31/2004
03/31/2004
03/31/2001
55
0
1,055
440
0
605
0
0
0
The new form will be used to evaluate
and monitor Independent Living Services for Older Individuals who
are blind related to; (a) the type of services provided and the
number of persons receiving each type of service, (b) the amounts
and percentage of funds reported on each type of service
provided.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.