Information Collection

Community Partner Protocol

IC 215175 under ICR 201502-0970-010 · OMB 0970-0456.

Documents and Forms

Document Name Document Type
Form 1 Community Partner Protocol Form and Instruction
1 Appendix II Surveys APPENDIX II Surveys.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Community Partner Protocol	Agency IC Tracking Number:	CB

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Appendix II Surveys	APPENDIX II Surveys.pdf		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: 34	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	34	34
Annual IC Time Burden (Hours)	9	9
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.