Information Collection

#2 - Mentor-Coach Census Survey Protocol Table

IC 198048 under ICR 201201-0970-003 · OMB 0970-0399.

Documents and Forms

Document Name Document Type
Attachment 2. Mentor-Coach Census Survey Protocol_110411_FINAL.doc Other-Attachment 2. Mentor-Coach Cen

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	#2 - Mentor-Coach Census Survey Protocol Table	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Other-Attachment 2. Mentor-Coach Census Survey Protocol_110411_FINAL			Attachment 2. Mentor-Coach Census Survey Protocol_110411_FINAL.doc		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	500	100	400
Annual IC Time Burden (Hours)	250	50	200
Annual IC Cost Burden (Dollars)	5,435	1,087	4,348

Documents for IC

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