Targeted Capacity Expansion Grants for Jail Diversion Programs - Baseline

Targeted Capacity Expansion Grants for Jail Diversion Programs

Documents and Forms

Document Name Document Type
Form Baseline Interview Targeted Capacity Expansion Grants for Jail Diversion Programs - Baseline Form and Instruction
Baseline Interview Baseline Interview A Baseline Interview 12.27.12.pdf Form and Instruction
I Follow-up Interview Reminder Letter.doc Follow-up Interview Reminder Letter IC Document
H Example of an Informed Consent Form.doc Example of an Informed Consent Form IC Document

Information Collection (IC) Details

IC Title:	Targeted Capacity Expansion Grants for Jail Diversion Programs - Baseline	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Form and Instruction	Baseline Interview	Baseline Interview	A Baseline Interview 12.27.12.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 378	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	378	-755	1,133
Annual IC Time Burden (Hours)	243	-745	988
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Follow-up Interview Reminder Letter	I Follow-up Interview Reminder Letter.doc	08/24/2012
Example of an Informed Consent Form	H Example of an Informed Consent Form.doc	08/24/2012

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