Information Collection

Follow-up Survey-12 Months

IC 189110 under ICR 200905-0970-001 · OMB 0970-0383.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0383 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Follow-up Survey Follow-up Survey-12 Months	Form and Instruction
Follow-up Survey Follow-up Survey TLP Followup Survey 4 2.doc	Form and Instruction

IC Title:

Follow-up Survey-12 Months

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
Form and Instruction	Follow-up Survey	Follow-up Survey	TLP Followup Survey 4 2.doc		No	No	Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 760

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	760	760
Annual IC Time Burden (Hours)	380	380
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.