Instrument 4b: Introductory script - HM Program Applicants

Parents and Children Together (PACT) Evaluation

Documents and Forms

Document Name Document Type
PACT Instrument (4) - HM Introductory Script - 6-17-13 clean.docx Other-Script

Information Collection (IC) Details

IC Title:	Instrument 4b: Introductory script - HM Program Applicants	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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-Script			PACT Instrument (4) - HM Introductory Script - 6-17-13 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: 4,210	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	4,210	4,210
Annual IC Time Burden (Hours)	703	703
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.