Implementation Drivers Web Survey

Permanency Innovations Initiative (PII) Evaluation - Phase 4

Documents and Forms

Document Name Document Type
Implementation Drivers Web Survey 7-19-12.docx Other-Survey
Sample screen shot for web based surveys.JPG Sample screen shot for web based surveys IC Document

Information Collection (IC) Details

IC Title:	Implementation Drivers Web Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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-Survey			Implementation Drivers Web Survey 7-19-12.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: 76	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	152	-136	288
Annual IC Time Burden (Hours)	122	-108	230
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Sample screen shot for web based surveys	Sample screen shot for web based surveys.JPG	05/08/2012

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