Information Collection

NCCC Successful Service Intervention Survey

IC 197671 under ICR 201102-3045-002 · OMB 3045-0138.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3045-0138 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NCCC Successful Service Intervention Survey	Form and Instruction
1 Successful Service Intervention Survey NCCC Successful Service FINAL 5.25.11.doc www.nationalservice.gov	Form and Instruction

IC Title:

NCCC Successful Service Intervention Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 12501

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	1	Successful Service Intervention Survey	NCCC Successful Service FINAL 5.25.11.doc	www.nationalservice.gov	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 660

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	660	660
Annual IC Time Burden (Hours)	88	88
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.