Information Collection

Targeted Capacity Expansion Grants for Jail Diversion Programs - Baseline

IC 7692 under ICR 201209-0930-002 · OMB 0930-0277.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.