Information Collection

Collection Instruments - Individuals

IC 182736 under ICR 200711-0584-003 · OMB 0584-0547.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0547 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Participants Focus Groups Discussion Guide.pdf	Other-Focus Group Discussion Guide
Information Form.pdf	Other-Focus Group Information Form
Intercept Interview.pdf	Other-Interview
Participants Focus Groups Discussion Guide.pdf	Other-Discussion Guide

IC Title:

Collection Instruments - Individuals

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Focus Group Discussion Guide	Participants Focus Groups Discussion Guide.pdf	No	Paper Only
Other-Focus Group Information Form	Information Form.pdf	No	Paper Only
Other-Interview	Intercept Interview.pdf	No	Paper Only
Other-Discussion Guide	Participants Focus Groups Discussion Guide.pdf	No	Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 336

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	840	840
Annual IC Time Burden (Hours)	521	521
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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