OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

24 month Followup survey California and Texas

IC 223049 under ICR 201604-0990-002 · OMB 0990-0424.

Documents and Forms
Document Name
Document Type
Other-survey
Other-survey
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

24 month Followup survey California and Texas
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-survey Instrument 1- CA_24 Month Followup Survey.docx Yes Yes Fillable Fileable
Other-survey Instrument 2- TX_24 Month Followup Survey.docx Yes Yes Fillable Printable

Health Health Care Services

 

505 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 505 0 505 0 0 0
Annual IC Time Burden (Hours) 253 0 253 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Overview of the PAF Attachment A_ Overview of the PAF Evaluation_FU.docx 08/16/2016
Source Table Attachment B_Question by Question Source Table for the PAF Follow Up.docx 08/16/2016
Sources Referenced Attachment C_Sources Referenced for PAF Follow Up.docx 08/16/2016
Person Consulted Attachment D_Persons Consulted.docx 08/16/2016
PAF Analysis Plan Attachment F_PAF Analysis Plan for Impact Study_FU.docx 08/16/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.