Information Collection

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

IC 10364 under ICR 200306-0990-003 · OMB 0990-0238.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,164

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4,164	-8,586	12,750
Annual IC Time Burden (Hours)	9,819	0	9,819
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.