Information Collection

HPOG-NIE 15-month Participant Follow-Up survey

IC 206801 under ICR 201408-0970-008 · OMB 0970-0394.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0394 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HPOG Appendix I HPOG-Impact 15-Month Partic Follow-Up Survey and HPOG-NIE Treatment revised 7 26 13.docx	Other-Survey

IC Title:

HPOG-NIE 15-month Participant Follow-Up survey

Agency IC Tracking Number:

Is this a Common Form? No

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-Survey			HPOG Appendix I HPOG-Impact 15-Month Partic Follow-Up Survey and HPOG-NIE Treatment revised 7 26 13.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: 200

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	200	-100	300
Annual IC Time Burden (Hours)	140	-70	210
Annual IC Cost Burden (Dollars)	0	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.