Information Collection

Comparison group of care recipients - Baseline

IC 218729 under ICR 201510-0985-001 · OMB 0985-0052.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0052 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Comparison group of care recipients - Baseline	Form and Instruction
1 Comparison Group Care Recipient Survey Appendix_O_ComparisonGroupCareRecipientSurvey_Baseline.docx	Form and Instruction

IC Title:

Comparison group of care recipients - Baseline

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	Comparison Group Care Recipient Survey	Appendix_O_ComparisonGroupCareRecipientSurvey_Baseline.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: 1,250

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
Annual Number of Responses for this IC	1,250	1,250
Annual IC Time Burden (Hours)	200	200
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.