Telephone Survey

ConnectHome Telephone Survey

Documents and Forms

Document Name Document Type
REVISED Phone Survey_8-3-16_toHUD (Appendix B).docx Other-Telephone Survey
Spanish phone survey_clean_final.docx Other-Telephone Survey (Spanish)
REVISED Phone Survey_01-12-17_toHUD in response to OMB comments on Health questions.docx Other-Revised Telephone Survey
Revised advance notification letter_6-29-16_toHUD (Appendix A).docx Advance Notification IC Document
Spanish translation_clean_advance letter.docx Advanced Notification (Spanish) IC Document

Information Collection (IC) Details

IC Title:	Telephone Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Telephone Survey	REVISED Phone Survey_8-3-16_toHUD (Appendix B).docx	No	Paper Only
Other-Telephone Survey (Spanish)	Spanish phone survey_clean_final.docx	No	Paper Only
Other-Revised Telephone Survey	REVISED Phone Survey_01-12-17_toHUD in response to OMB comments on Health questions.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: 2,500	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	2,500	2,500
Annual IC Time Burden (Hours)	1,250	1,250
Annual IC Cost Burden (Dollars)	37,500	37,500

Documents for IC

Title	Document	Date Uploaded
Advance Notification	Revised advance notification letter_6-29-16_toHUD (Appendix A).docx	08/17/2016
Advanced Notification (Spanish)	Spanish translation_clean_advance letter.docx	09/28/2016

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