Information Collection

Evaluation of the Aging and Disability Resource Center Program

IC 203776 under ICR 201208-0985-003 · OMB 0985-0035.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0985-NEW Evaluation of the Aging and Disability Resource Center Program	Form and Instruction
0985-NEW Final ADRC Evaluation FINAL ADRC Evaluation Data Collection Instruments for 30-day notice 5-14-12.pdf	Form and Instruction

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0985-NEW	Final ADRC Evaluation	FINAL ADRC Evaluation Data Collection Instruments for 30-day notice 5-14-12.pdf		No	No	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 9,562

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	9,562	9,562
Annual IC Time Burden (Hours)	2,060	2,060
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.