Information Collection

PHA staff preparation for site visits

IC 198778 under ICR 201108-2528-002 · OMB 2528-0267.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HCV Pretest_Draft Appendix D_(8.5.11).doc	Other-Study Advance Letter
HCV Pretest_Draft Appendix D_12-2-11.doc	Other-Study Advance Letter
HCV Pretest_Appendix A2_1-31-12.doc	Other-Site Visit Preparation Package

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Study Advance Letter	HCV Pretest_Draft Appendix D_12-2-11.doc	No		Paper Only
Other-Study Advance Letter	HCV Pretest_Draft Appendix D_(8.5.11).doc	No		Paper Only
Other-Site Visit Preparation Package	HCV Pretest_Appendix A2_1-31-12.doc	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	96	96
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.