Information Collection

#2 - Mentor-Coach Census Survey Protocol Table

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 2. Mentor-Coach Census Survey Protocol_110411_FINAL.doc	Other-Attachment 2. Mentor-Coach Cen

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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					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 %

table that charts list of burden
	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

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.

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