Information Collection

Survey of Participating Jurisdicitons in ADDI/HOME Programs

IC 182648 under ICR 200711-2528-001 · OMB 2528-0253.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Data Verification and Collection.doc	Other-Survey - Data Verificaiton and
Program Characteristics Questionnaire.doc	Other-Program Characteristics Questi
Concentrance Letter.doc Concentrance Letter	IC Document
telephone script.doc Telephone Script	IC Document

IC Title:

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey - Data Verificaiton and Collection			Data Verification and Collection.doc		Yes	Yes	Fillable Fileable
Other-Program Characteristics Questionnaire			Program Characteristics Questionnaire.doc		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Homeownership Promotion

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 116

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	116	116
Annual IC Time Burden (Hours)	1,392	1,392
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Concentrance Letter	Concentrance Letter.doc	11/08/2007
Telephone Script	telephone script.doc	11/08/2007

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