Information Collection

Alternative Housing Pilot Program Evaluation Baseline Survey

IC 180053 under ICR 200803-2528-001 · OMB 2528-0248.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Survey 5_5.doc	Other-Survey
Consent Form 5_5.doc	Other-Consent Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 24 CFR 990

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			Survey 5_5.doc		Yes	No	Fillable Printable
Other-Consent Form			Consent Form 5_5.doc		Yes	No	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Homeownership Promotion

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 30 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	10,000	10,000
Annual IC Time Burden (Hours)	4,167	4,167
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.