Adult Program Pilot

Office of Financial Education and Financial Access Assessing Financial Capability Outcomes (AFCO) Pilot

Documents and Forms

Document Name Document Type
adult pilot_ post card 01.05.11.docx Other-Post Card
adult pilot_Baseline Survey_01.16.11 .docx Other-Survey
adult pilot_BP data release form.doc Other-Release
adult pilot_consent form_12.15.12.doc Other-Consent
adult pilot_consent script 01.15.12.docx Other-Consent Script
adult pilot_cover letters_POP 01.15.12 .docx Other-Cover Letter
adult pilot_FUsurvey_01.15.12 .docx Other-Survey
adult pilot_onsite survey guidance 01.15.12.docx Other-Survey Guidance
Adult Survey Reminders_MAY2012.pdf Other-Post Card REV
Adult Survey Cover Letters_MAY2012.pdf Other-Cover Letter REV
Adult Follow-up Survey_MAY2012.pdf Other-Survey REV

Information Collection (IC) Details

IC Title:	Adult Program Pilot	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Post Card	adult pilot_ post card 01.05.11.docx	Yes	No	Printable Only
Other-Survey	adult pilot_Baseline Survey_01.16.11 .docx	Yes	No	Printable Only
Other-Release	adult pilot_BP data release form.doc	Yes	No	Printable Only
Other-Consent	adult pilot_consent form_12.15.12.doc	Yes	No	Printable Only
Other-Consent Script	adult pilot_consent script 01.15.12.docx	Yes	No	Printable Only
Other-Cover Letter	adult pilot_cover letters_POP 01.15.12 .docx	Yes	No	Printable Only
Other-Survey	adult pilot_FUsurvey_01.15.12 .docx	Yes	No	Printable Only
Other-Survey Guidance	adult pilot_onsite survey guidance 01.15.12.docx	Yes	No	Printable Only
Other-Post Card REV	Adult Survey Reminders_MAY2012.pdf	Yes	No	Printable Only
Other-Cover Letter REV	Adult Survey Cover Letters_MAY2012.pdf	Yes	No	Printable Only
Other-Survey REV	Adult Follow-up Survey_MAY2012.pdf	Yes	No	Printable Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,031	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	Previously Approved
Annual Number of Responses for this IC	1,031	31	1,000
Annual IC Time Burden (Hours)	452	-548	1,000
Annual IC Cost Burden (Dollars)	0	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.