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Provider Staff Supervisior/Admin.
Triennial Evaluation of the Projects for Assistance in Transition from Homelessness (PATH)
OMB: 0930-0332
IC ID: 199304
OMB.report
HHS/SAMHSA
OMB 0930-0332
ICR 201109-0930-001
IC 199304
( )
Documents and Forms
Document Name
Document Type
Form Provider Site Visi
Provider Staff Supervisior/Admin.
Form and Instruction
Provider Site Visi Provider Site Visit Interview Guide
Attachment_B_PATH_Provider_Site_Visit_Interview_Guide_Supervisor_Administrator[1].docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Provider Staff Supervisior/Admin.
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
Form and Instruction
Provider Site Visit Interview Guide
Provider Site Visit Interview Guide
Attachment_B_PATH_Provider_Site_Visit_Interview_Guide_Supervisor_Administrator[1].docx
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
10
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
10
0
10
0
0
0
Annual IC Time Burden (Hours)
7
0
7
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.