Information Collection

New Instrument #2 15 Month Follow-Up Survey, HPOG Questions Addition

IC 206403 under ICR 201304-0970-001 · OMB 0970-0397.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0397 can be found here:

Documents and Forms

Document Name Document Type
ISIS Follow-Up 7-23-2013 ACT Illustrative for OMB clean.docx Other-Survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	New Instrument #2 15 Month Follow-Up Survey, HPOG Questions Addition	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
Other-Survey			ISIS Follow-Up 7-23-2013 ACT Illustrative for OMB clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 991	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	991	991
Annual IC Time Burden (Hours)	82	82
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.