Project Impact Survey

ANA Project Impact Assessment Survey

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0379 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Project Impact Survey Form and Instruction
1 Project Assessment Tool ACF-ANA-Project-Impact-Assessment Tool.pdf Form and Instruction
Project Impact Assessment Survey Notification Letter.doc Letter IC Document
Chapter 2 - Project Impact Assessment Survey Manual.doc Manual IC Document

Information Collection (IC) Details

IC Title:	Project Impact Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Project Assessment Tool	ACF-ANA-Project-Impact-Assessment Tool.pdf		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 85	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	85	85
Annual IC Time Burden (Hours)	510	510
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Letter	Project Impact Assessment Survey Notification Letter.doc	05/15/2013
Manual	Chapter 2 - Project Impact Assessment Survey Manual.doc	05/15/2013

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