Information Collection

Implementation Drivers Web Survey

IC 202188 under ICR 201205-0970-003 · OMB 0970-0408.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0408 can be found here:

Documents and Forms

Document Name Document Type
Implementation Drivers Web Survey 7-19-12.docx Other-Survey
Sample screen shot for web based surveys.JPG Sample screen shot for web based surveys IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Implementation Drivers Web Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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-Survey			Implementation Drivers Web Survey 7-19-12.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	240	240
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Sample screen shot for web based surveys	Sample screen shot for web based surveys.JPG	05/08/2012

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