Information Collection

Independent Living Facility Screener for American Housing Survey

IC 187824 under ICR 200701-0607-003 · OMB 0607-0809.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0809 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AHS-101AR Independent Living Facility Screener for American Housing Survey	Form
privacy statement.wpd	Other-Privacy Statement
AHS-101AR Age Restricted Living Screener Questionnaire (American H ahs101ar_12-29-08 Draft.pdf	Form
AL09_Screening_Notification 1-13-09. wpd.wpd AHS Independent Living Facility Screener -- Plan	IC Document

IC Title:

Independent Living Facility Screener for American Housing Survey

Agency IC Tracking Number:

IC Status: New

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
Form	AHS-101AR	Age Restricted Living Screener Questionnaire (American Housing Survey)	ahs101ar_12-29-08 Draft.pdf		No		Paper Only
Other-Privacy Statement			privacy statement.wpd		No		Paper Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 24

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	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	24	0	0	0	0	0
Annual IC Time Burden (Hours)	2	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
AHS Independent Living Facility Screener -- Plan	AL09_Screening_Notification 1-13-09. wpd.wpd	01/16/2009

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