Supplemental Baseline Questions (program participants and control group members)

Health Profession Opportunity Grants (HPOG) program

OMB: 0970-0394

IC ID: 202864

Documents and Forms
Document Name
Document Type
Other-Supplemental Questions
Information Collection (IC) Details

View Information Collection (IC)

Supplemental Baseline Questions (program participants and control group members)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Supplemental Questions Instrument 1_Supplemental Baseline Data 6-7-12.doc Yes Yes Fillable Fileable

Community and Social Services Social Services

 

5,250 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 5,250 0 125 0 0 5,125
Annual IC Time Burden (Hours) 1,313 0 32 0 0 1,281
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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