Information Collection

Students enrolled in University-Based Workforce program(Baseline survey)

IC 197598 under ICR 201208-0955-004 · OMB 0955-0004.

Documents and Forms

Document Name Document Type
Attachment_1_-_Proposed_UBT_Student_Baseline_Web_Questionnaire.docx Other-survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Students enrolled in University-Based Workforce program(Baseline 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			Attachment_1_-_Proposed_UBT_Student_Baseline_Web_Questionnaire.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 634	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
Annual Number of Responses for this IC	634	634
Annual IC Time Burden (Hours)	211	211
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.