Patient Follow-up Survey for the Multi-site Evaluation of the Welfare-to-Work Grants Program

ICR 200306-0990-003

OMB: 0990-0238

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0990-0238 200306-0990-003
Historical Active 200004-0990-001
HHS/HHSDM
Patient Follow-up Survey for the Multi-site Evaluation of the Welfare-to-Work Grants Program
Extension without change of a currently approved collection   No
Regular
Approved without change 08/11/2003
Retrieve Notice of Action (NOA) 06/16/2003
Approved for use through 8/2004 to allow additional time needed for enrollment of the evaluation sample.
  Inventory as of this Action Requested Previously Approved
08/31/2004 08/31/2004 08/31/2003
4,164 0 12,750
9,819 0 9,819
0 0 0

These survey protocols will enable HHS to gather in-depth information from WtW grantees, partners, and client on program experiences as part of the Congressionally mandated evaluation of the WtW program.

None
None


No

1
IC Title Form No. Form Name
Patient Follow-up Survey for the Multi-site Evaluation of the Welfare-to-Work Grants Program

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 4,164 12,750 0 -8,586 0 0
Annual Time Burden (Hours) 9,819 9,819 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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.
06/16/2003


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