Information Collection

AHS Age Restricted Living Screening Operation

IC 194341 under ICR 201109-0607-001 · OMB 0607-0809.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0809 can be found here:

Documents and Forms

Document Name Document Type
Form AHS-101AR AHS Age Restricted Living Screening Operation Form
Attachment 2.docx Other-Confidentiality Notice
AHS-101AR AHS Age Restricted Living Screener Questionnaire Attachment 1.docx Form
AHS Age Restricted Screener OMB Request.docx AHS Age Restricted Living Screening Plan IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	AHS Age Restricted Living Screening Operation	Agency IC Tracking Number:

IC Status: Unchanged

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
Form	AHS-101AR	AHS Age Restricted Living Screener Questionnaire	Attachment 1.docx		No		Paper Only
Other-Confidentiality Notice			Attachment 2.docx		No		Paper Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 599	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	599	599
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
AHS Age Restricted Living Screening Plan	AHS Age Restricted Screener OMB Request.docx	08/20/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.