Information Collection

Adult Program Pilot

IC 200242 under ICR 201111-1505-004 · OMB 1505-0242.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1505-0242 can be found here:

Documents and Forms

Document Name Document Type
adult pilot_ post card 01.05.11.docx Other-Post Card
adult pilot_Baseline Survey_01.16.11 .docx Other-Survey
adult pilot_BP data release form.doc Other-Release
adult pilot_consent form_12.15.12.doc Other-Consent
adult pilot_consent script 01.15.12.docx Other-Consent Script
adult pilot_cover letters_POP 01.15.12 .docx Other-Cover Letter
adult pilot_FUsurvey_01.15.12 .docx Other-Survey
adult pilot_onsite survey guidance 01.15.12.docx Other-Survey Guidance

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Adult Program Pilot	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey	adult pilot_FUsurvey_01.15.12 .docx	Yes	No	Printable Only
Other-Release	adult pilot_BP data release form.doc	Yes	No	Printable Only
Other-Consent	adult pilot_consent form_12.15.12.doc	Yes	No	Printable Only
Other-Consent Script	adult pilot_consent script 01.15.12.docx	Yes	No	Printable Only
Other-Survey	adult pilot_Baseline Survey_01.16.11 .docx	Yes	No	Printable Only
Other-Survey Guidance	adult pilot_onsite survey guidance 01.15.12.docx	Yes	No	Printable Only
Other-Cover Letter	adult pilot_cover letters_POP 01.15.12 .docx	Yes	No	Printable Only
Other-Post Card	adult pilot_ post card 01.05.11.docx	Yes	No	Printable Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	1,000	1,000
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.