Information Collection

Special Initiative Survey

IC 218714 under ICR 201502-0970-004 · OMB 0970-0401.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0401 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Special Initiative Survey	Form and Instruction
1 Special Initiative Survey CWIGSpecialInitiativeSurvey_forOMB_10-23-15.docx	Form and Instruction
OMBFastTrackApplication_SpecialInitiativeSurvey_10-23-15.doc Justification for Special Initiative	IC Document

IC Title:

Special Initiative Survey

Agency IC Tracking Number:

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	Special Initiative Survey	CWIGSpecialInitiativeSurvey_forOMB_10-23-15.docx		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: 600

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	600	600
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification for Special Initiative	OMBFastTrackApplication_SpecialInitiativeSurvey_10-23-15.doc	10/28/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.