Information Collection

Senior Corps Surveys

IC 203076 under ICR 201301-3045-002 · OMB 3045-0146.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Caregiver Survey Senior Corps Surveys	Form and Instruction
Form 1 Client Survey Senior Corps Surveys	Form and Instruction
Form 3 Volunteer Survey Senior Corps Surveys	Form and Instruction
1 Client Survey SCP Independent Living Survey FINAL January 23 2013.doc	Form and Instruction
2 Caregiver Survey SCP Respite Survey FINAL January 23 2013.doc	Form and Instruction
3 Volunteer Survey Senior Corps Volunteer Performance Measure Survey FINAL January 23 2013.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 5056

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Electronic Capability
Form and Instruction	1	No	Paper Only
Form and Instruction	2	No	Paper Only
Form and Instruction	3	No	Paper Only

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120,000

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	Previously Approved
Annual Number of Responses for this IC	120,000	120,000
Annual IC Time Burden (Hours)	60,000	60,000
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.

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