Information Collection

New Instrument #2 15 Month Follow-Up Survey, HPOG Questions Addition

IC 206403 under ICR 201407-0970-003 · OMB 0970-0397.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0397 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ISIS Follow-Up 7-23-2013 ACT Illustrative for OMB clean.docx	Other-Survey

IC Title:

New Instrument #2 15 Month Follow-Up Survey, HPOG Questions Addition

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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-Survey			ISIS Follow-Up 7-23-2013 ACT Illustrative for OMB 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: 991

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	991	991
Annual IC Time Burden (Hours)	82	82
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.