Information Collection

Outcome Survey

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.