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Instrument 5: Baseline survey - HM Study Participants

IC 206001 under ICR 201310-0970-004 · OMB 0970-0403.

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

View Information Collection (IC)

Instrument 5: Baseline survey - HM Study Participants
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Survey PACT Instrument (5) - Baseline Survey for Participants in Healthy Marria.docx Yes Yes Fillable Fileable

Community and Social Services Social Services

 

4,000 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 4,000 0 0 0 0 4,000
Annual IC Time Burden (Hours) 2,000 0 0 0 0 2,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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