Information Collection

Domestic Violence and Housing Technical Assistance Consortium Safe Housing Needs Assessment

IC 225896 under ICR 201612-1122-001 · OMB 1122-0033.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1122-XXX Domestic Violence and Housing Technical Assistance Consortium Safe Housing Needs Assessment	Form
1122-XXX Safe Housing Needs Assessment Homeless Shelter and Housing Providers_Feedback Incorporated_NASH.pdf	Form
1122-XXXX Safe Housing Needs Assessment Domestic and Sexual Violence Organizations_ Needs Assessment Questions_Final with RevisionIncorporation_NASH (003).pdf	Form

IC Title:

Agency IC Tracking Number:

1122-XXXX

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1122-XXX	Safe Housing Needs Assessment	Homeless Shelter and Housing Providers_Feedback Incorporated_NASH.pdf	www.usdoj.gov/ovw	Yes	Yes	Fillable Fileable Signable
Form	1122-XXXX	Safe Housing Needs Assessment	Domestic and Sexual Violence Organizations_ Needs Assessment Questions_Final with RevisionIncorporation_NASH (003).pdf	www.usdoj.gov/ovw	Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 78,660

Number of Respondents for Small Entity: 78,660

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	78,660	78,660
Annual IC Time Burden (Hours)	19,665	19,665
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.