Information Collection

Appendix U Participant 30-month survey

IC 211534 under ICR 201506-0970-017 · OMB 0970-0413.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix U STED ETJD 30MOS Survey Instrument OMB Highlights - updated August 2014.docx	Other-Survey

IC Title:

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			Appendix U STED ETJD 30MOS Survey Instrument OMB Highlights - updated August 2014.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: 3,947

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	3,947	3,947
Annual IC Time Burden (Hours)	1,974	1,974
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.