Information Collection

Independent Living Performance Measures Aggregation Tool

IC 207237 under ICR 201701-3045-001 · OMB 3045-0152.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Data Aggregation Tool Independent Living Performance Measures Aggregation Tool	Form
Form 2 Independent Living Survey Independent Living Performance Measures Aggregation Tool	Form and Instruction
Form 3 Respite Survey Independent Living Performance Measures Aggregation Tool	Form and Instruction
DAT Instructions.doc	Instruction
1 Data Aggregation Tool Copy of Data Aggregation Tool .xls	Form
2 Independent Living Survey SCP Independent Living Survey FINAL.doc	Form and Instruction
3 Respite Survey SCP Respite Survey FINAL.doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	www.nationalservice.gov	Yes	Yes	Fillable Fileable
Instruction		www.nationalservice.gov	Yes	Yes	Printable Only
Form and Instruction	2	www.nationalservice.gov	Yes	Yes	Fillable Fileable
Form and Instruction	3	www.nationalservice.gov	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 53,470

Number of Respondents for Small Entity: 0

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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	53,470	53,120	350
Annual IC Time Burden (Hours)	26,735	24,285	2,450
Annual IC Cost Burden (Dollars)	0	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.

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