Information Collection

Street Outreach Program Data Collection Project

IC 203685 under ICR 201305-0970-007 · OMB 0970-0356.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0356 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment B Interview Questions revised-clean.pdf	Other-Interview
Attachment F Focus Group Questions revised-clean.pdf	Other-Focus Group
SOP Data Collection Project -- SSA Template revised-clean.pdf SOP Data Collection Project -- SSA Template revised-clean	IC Document
Attach C Seed Coupon.pdf Attach C Seed Coupon	IC Document
Attach D Focus Group Brochure.pdf Attach D Focus Group Brochure	IC Document
Attachment H Interview Consent Non-Seed revised-clean.pdf Attachment H Interview Consent Non-Seed revised-clean	IC Document
Attach I IRB Approval.pdf Attach I IRB Approval	IC Document
SOP DC Project-OMB Information Request -- References List.docx SOP DC Project-OMB Information Request -- References List	IC Document
Attachment A Interview Brochure revised-clean.pdf Attachment A Interview Brochure revised-clean	IC Document
SOP Data Collection Project -- SSB Template revised-clean.pdf SOP Data Collection Project -- SSB Template revised-clean	IC Document
Attachment E Focus Group Consent revised-clean.pdf Attachment E Focus Group Consent revised-clean	IC Document
Attachment G Interview Consent Seed revised-clean.pdf Attachment G Interview Consent Seed revised-clean	IC Document

IC Title:

Street Outreach Program Data Collection Project

Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Interview			Attachment B Interview Questions revised-clean.pdf		Yes	Yes	Fillable Fileable
Other-Focus Group			Attachment F Focus Group Questions revised-clean.pdf		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: 880

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	880	880
Annual IC Time Burden (Hours)	1,100	1,100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SOP Data Collection Project -- SSA Template revised-clean	SOP Data Collection Project -- SSA Template revised-clean.pdf	05/16/2013
Attach C Seed Coupon	Attach C Seed Coupon.pdf	08/13/2012
Attach D Focus Group Brochure	Attach D Focus Group Brochure.pdf	08/13/2012
Attachment H Interview Consent Non-Seed revised-clean	Attachment H Interview Consent Non-Seed revised-clean.pdf	05/16/2013
Attach I IRB Approval	Attach I IRB Approval.pdf	08/13/2012
SOP DC Project-OMB Information Request -- References List	SOP DC Project-OMB Information Request -- References List.docx	08/13/2012
Attachment A Interview Brochure revised-clean	Attachment A Interview Brochure revised-clean.pdf	05/16/2013
SOP Data Collection Project -- SSB Template revised-clean	SOP Data Collection Project -- SSB Template revised-clean.pdf	05/16/2013
Attachment E Focus Group Consent revised-clean	Attachment E Focus Group Consent revised-clean.pdf	05/16/2013
Attachment G Interview Consent Seed revised-clean	Attachment G Interview Consent Seed revised-clean.pdf	05/16/2013

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