Information Collection

iCare Nuts and Bolts Post Class Survey

IC 203845 under ICR 201205-0917-002 · OMB 0917-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0036 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0917-0036-09 iCare Nuts and Bolts Post Class Survey	Form and Instruction
0917-0036-09 OMB Form No. 0917-0036-09, iCare Nuts and Bolts Post Cla OMB Form No. 0917-0036-09, iCare NutsAndBolts.pdf	Form and Instruction
OMB Form No. 0917-0036-09, Mini-Supporting Statement.pdf Mini-Supporting Statemetn for OMB Form No. 0917-0036-09	IC Document

IC Title:

iCare Nuts and Bolts Post Class Survey

Agency IC Tracking Number:

IC Status: New

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
Form and Instruction	0917-0036-09	OMB Form No. 0917-0036-09, iCare Nuts and Bolts Post Class Survey	OMB Form No. 0917-0036-09, iCare NutsAndBolts.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 225

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	225	225
Annual IC Time Burden (Hours)	19	19
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Mini-Supporting Statemetn for OMB Form No. 0917-0036-09	OMB Form No. 0917-0036-09, Mini-Supporting Statement.pdf	07/11/2012

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