Information Collection

Survey of Supervised Visitation and Safe Exchange Program Grantees and Partners

IC 208466 under ICR 201309-1122-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1122-XXXX Survey of Supervised Visitation and Safe Exchange Program Grantees and Partners	Form
1122-XXXX Safe Haven 10 year Grantee Survey Safe Havens 10 Year Grantee Survey.docx www.surveymonkey.com/s/safe-havens-10-year-survey	Form

IC Title:

Agency IC Tracking Number:

1122-XXXX

Is this a Common Form? Yes

IC Status: New

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
Form	1122-XXXX	Safe Haven 10 year Grantee Survey	Safe Havens 10 Year Grantee Survey.docx	https://www.surveymonkey.com/s/safe-havens-10-year-survey	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: 800

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	400	400
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.