Information Collection

Street Outreach Program Data Collection Project

IC 203685 under ICR 201208-0970-001 · OMB 0970-0356.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0356 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attach B Interview Questions.pdf	Other-Computer- Assisted Personal In
Attach F Focus Group Questions.pdf	Other-Focus Group
SOP Data Collection Project -- SSB Template 081012.doc SOP Data Collection Project -- SSB Template 081012	IC Document
Attach A Interview Brochure.pdf Attach A Interview Brochure	IC Document
Attach C Seed Coupon.pdf Attach C Seed Coupon	IC Document
Attach D Focus Group Brochure.pdf Attach D Focus Group Brochure	IC Document
Attach E Focus Group Consent.pdf Attach E Focus Group Consent	IC Document
Attach G Interview Consent-Seed.pdf Attach G Interview Consent-Seed	IC Document
Attach H Interview Consent Non-Seed.pdf Attach H Interview Consent Non-Seed	IC Document
Attach I IRB Approval.pdf Attach I IRB Approval	IC Document
SOP DC Project-OMB Information Request -- References List.docx SOP DC Project-OMB Information Request -- References List	IC Document
SOP Data Collection Project -- SSA Template 081012.doc SOP Data Collection Project -- SSA Template 081012	IC Document

IC Title:

Street Outreach Program Data Collection Project

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
Other-Computer- Assisted Personal Interviews			Attach B Interview Questions.pdf		Yes	Yes	Fillable Fileable
Other-Focus Group			Attach F Focus Group Questions.pdf		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: 880

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 New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	880	0	0	0	0	0
Annual IC Time Burden (Hours)	1,100	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SOP Data Collection Project -- SSB Template 081012	SOP Data Collection Project -- SSB Template 081012.doc	08/13/2012
Attach A Interview Brochure	Attach A Interview Brochure.pdf	08/13/2012
Attach C Seed Coupon	Attach C Seed Coupon.pdf	08/13/2012
Attach D Focus Group Brochure	Attach D Focus Group Brochure.pdf	08/13/2012
Attach E Focus Group Consent	Attach E Focus Group Consent.pdf	08/13/2012
Attach G Interview Consent-Seed	Attach G Interview Consent-Seed.pdf	08/13/2012
Attach H Interview Consent Non-Seed	Attach H Interview Consent Non-Seed.pdf	08/13/2012
Attach I IRB Approval	Attach I IRB Approval.pdf	08/13/2012
SOP DC Project-OMB Information Request -- References List	SOP DC Project-OMB Information Request -- References List.docx	08/13/2012
SOP Data Collection Project -- SSA Template 081012	SOP Data Collection Project -- SSA Template 081012.doc	08/13/2012

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