Information Collection

ConnectHome Baseline Survey

IC 218649 under ICR 201510-2528-002 · OMB 2528-0308.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2528-0308 can be found here:

Documents and Forms

Document Name Document Type
Formatted ConnectHome Baseline Survey 11-16-15.docx Other-Baseline Survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	ConnectHome Baseline Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Baseline Survey			Formatted ConnectHome Baseline Survey 11-16-15.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,800	2,800
Annual IC Time Burden (Hours)	233	233
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.