Information Collection Request

Family Self-Sufficiency Program Evaluation

ICR 201607-2528-002 · OMB 2528-0296 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
PIH - 50058 Form.pdf Supplementary Document Uploaded 2016-07-29 Available
FSS Evaluation 30-Day Notice 7_29_16.pdf Supplementary Document Uploaded 2016-07-29 Available
60-day notice for FSS (7_29_16).pdf Supplementary Document Uploaded 2016-07-29 Available
FSS EVALUATION OMB PACKET PART A - APPENDIX INFORMED CONSENT FORM.doc Supplementary Document Uploaded 2016-07-29 Available
Supporting Statement B_07_28_2016.docx Supporting Statement B Uploaded 2016-07-29 Available
FSS Supporting Statement A_07_29_2016.docx Supporting Statement A Uploaded 2016-07-29 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
205698 FSS Evaluation Other-Draft mini-survey questionnaire Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2019 36 Months From Approved 10/31/2016
2,551 0 4,958
1,913 0 4,416
0 0 0





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table that charts list of burden
IC Title Form No. Form Name
FSS Evaluation Baseline Information Form Adult, XX-XXXX, XX-XXXX, XX-XXXX Informed Consent ,   Baseline Information Form-Head of Household ,   XX-XXXX ,   36 Month Follow-up Survey

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,551 4,958 0 -2,407 0 0
Annual Time Burden (Hours) 1,913 4,416 0 -2,503 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No