Information Collection

12 month Tracking Outreach Log

IC 196964 under ICR 201012-2528-001 · OMB 2528-0268.

Documents and Forms

Document Name Document Type
Appendix E - Tracking Outreach Log 03-17-11.docx Other-Tracking Outreach Log

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	12 month Tracking Outreach Log	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-Tracking Outreach Log			Appendix E - Tracking Outreach Log 03-17-11.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 750	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	750	750
Annual IC Time Burden (Hours)	63	63
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.