Information Collection

Conduct the Victims with Disabilities in Homeless Shelters Pilot Survey

IC 232151 under ICR 201510-1121-007 · OMB 1121-0325.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Conduct the Victims with Disabilities in Homeless Shelters Pilot Survey	Form and Instruction
VDHS Pilot Survey Survey Instrument and Interview Protoc VDHS Instrument.pdf	Form and Instruction
OMB generic clearance memo VDHS.docx Memo to OMB on VDHS Pilot Study	IC Document
OMB attachments VDHS.pdf VDHS Attachments	IC Document

IC Title:

Agency IC Tracking Number:

BJS

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	N/A	VDHS Pilot Survey Survey Instrument and Interview Protocol	VDHS Instrument.pdf		Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Citizen Protection

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

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	100	100
Annual IC Time Burden (Hours)	58	58
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Memo to OMB on VDHS Pilot Study	OMB generic clearance memo VDHS.docx	07/11/2018
VDHS Attachments	OMB attachments VDHS.pdf	07/11/2018

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