Information Collection

Baseline and Follow Up Survey

IC 201275 under ICR 201202-2528-002 · OMB 2528-0287.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
VHPD OMB Part A Appendix B Baseline& Follow-up Surveys.docx	Other-Baseline & Follow Up Surveys
VHPD baseline client interview Draft 18 8-22-2012.docx	Other-Baseline Client Interview
VHPD follow up client interview 8-22-2012 - Draft 10.docx	Other-Follow Up Client Interview

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Baseline & Follow Up Surveys	VHPD OMB Part A Appendix B Baseline& Follow-up Surveys.docx	No	Paper Only
Other-Baseline Client Interview	VHPD baseline client interview Draft 18 8-22-2012.docx	No	Paper Only
Other-Follow Up Client Interview	VHPD follow up client interview 8-22-2012 - Draft 10.docx	No	Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 900

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	900	900
Annual IC Time Burden (Hours)	450	450
Annual IC Cost Burden (Dollars)	0	0

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.