OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

ConnectHome Baseline Survey

IC 218649 under ICR 201608-2528-001 · OMB 2528-0308.

Documents and Forms
Document Name
Document Type
Other-Baseline Survey English
Other-Baseline Survey Vietnamese
Other-Baseline Survey Spanish
Other-Baseline Survey Amharic
Other-Baeline Survey Arabic
Other-Baseline Survey Hmong
Other-Baseline Survey Chinese
Other-Baseline Survey Russian
Other-Baseline Survey Somali
Information Collection (IC) Details

View Information Collection (IC)

ConnectHome Baseline Survey
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Baseline Survey English Formatted ConnectHome Baseline Survey Revised 8_4_16.docx No   Paper Only
Other-Baseline Survey Vietnamese Formatted ConnectHome Baseline Survey-Vietnamese Revised 8_4_16.docx No   Paper Only
Other-Baseline Survey Spanish Formatted ConnectHome Baseline Survey-Spanish Revised 8_4_16.docx No   Paper Only
Other-Baseline Survey Amharic Formatted ConnectHome baseline Survey-Amharic Revised 8_4_16.doc No   Paper Only
Other-Baeline Survey Arabic Formatted ConnectHome Baseline Survey-Arabic Revised 8_4_16.docx No   Paper Only
Other-Baseline Survey Hmong Formatted ConnectHome Baseline Survey-Hmong Revised 8_4_16.docx No   Paper Only
Other-Baseline Survey Chinese Formatted ConnectHome Baseline Survey-S.Chinese Revised 8_4_16.docx No   Paper Only
Other-Baseline Survey Russian Formatted ConnectHome Baseline Survey-Russian Revised 8_4_16.docx No   Paper Only
Other-Baseline Survey Somali Formatted ConnectHome Baseline Survey-Somali Revised 8_4_16.docx No   Paper Only

Community and Social Services Social Services

 

2,800 0
   
Individuals or Households
 
   0 %

  Requested 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 2,800 0 0 0 2,800 0
Annual IC Time Burden (Hours) 233 0 0 0 233 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.