ConnectHome Focus Groups Screener

ConnectHome Use and Barriers Focus Groups

Documents and Forms

Document Name Document Type
PHA Residents Screener_for OMB Appendix A.docx Other-PHA Resident Screener

Information Collection (IC) Details

IC Title:	ConnectHome Focus Groups Screener	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-PHA Resident Screener			PHA Residents Screener_for OMB Appendix A.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 495	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	495	495
Annual IC Time Burden (Hours)	41	41
Annual IC Cost Burden (Dollars)	1,233	1,233

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.