Information Collection

#3 - Adult Survey Wave 2

IC 189521 under ICR 200906-0970-003 · OMB 0970-0339.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0339 can be found here:

Documents and Forms

Document Name Document Type
#3 - Adult Survey Wave 2.doc Other-#3 - Adult Survey Wave 2

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	#3 - Adult Survey Wave 2	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-#3 - Adult Survey Wave 2			#3 - Adult Survey Wave 2.doc		Yes	Yes	Printable Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,267	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,267	4,267
Annual IC Time Burden (Hours)	3,542	3,542
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.