Information Collection

Street Outreach Program: Youth Profile

IC 213522 under ICR 201409-0970-004 · OMB 0970-0123.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 RHYMIS 3.0 Data Measures Street Outreach Program: Youth Profile	Form and Instruction
1 RHYMIS 3.0 Data Measures 2015 RHYMIS 3.0 Data Measures_Final.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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 and Instruction	1				Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 138

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	72,312	72,312
Annual IC Time Burden (Hours)	5,279	5,279
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.

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