Information Collection

Outcome Survey

IC 204866 under ICR 201211-3170-005 · OMB 3170-0030.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3170-XXXX Outcome Survey	Form
Script for Completing the Outcome Survey FINAL.pdf	Instruction
3170-XXXX Outcome Survey Outcome Survey.pdf	Form

IC Title:

Outcome Survey

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	3170-XXXX	Outcome Survey	Outcome Survey.pdf		Yes	No	Fillable Printable
Instruction			Script for Completing the Outcome Survey FINAL.pdf		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 800

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 Agency Discretion
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	536	536
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.