Information Collection

Baseline Survey -- Treatment Group

IC 187985 under ICR 200901-0960-004 · OMB 0960-0726.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Baseline Questionnaire.doc	Other-Survey
MHTS Consent (incl FAQs).doc	Other-Consent Letter

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-Consent Letter			MHTS Consent (incl FAQs).doc		No		Paper Only
Other-Survey			Baseline Questionnaire.doc		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,121

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1,121	1,121
Annual IC Time Burden (Hours)	878	878
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.