Information Collection

Potential PFL-eligible low-income mothers

IC 219524 under ICR 201704-0990-009 · OMB 0990-0421.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0421 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-0421 revisedFocus Groups guide Attach B_Final.docx	Other-focus groups
0990-0421 revisedPhone_Screen_Attach A_Final.docx	Other-survey
0990-0421 revisedPFL DemoQuestion Attach C_Final.docx	Other-questions
0990-0421 revisedSupportingStatementB_PFL_Final.docx SS part B: Exploring the Relationship between the CA Paid Family Leave Program and the Well-Being of Low-Income Families	IC Document
0990-0421 revised2SupportingStatementA_PFL_Final.docx Support St. A: Exploring the Relationship between the CA Paid Family Leave Program and the Well-Being of Low-Income Families	IC Document
0990-0421 revised2ASPE Generic - Short Supporting Statement cover sheet_PFL Project _FINAL.docx Mini SS: Exploring the Relationship between the CA Paid Family Leave Program and the Well-Being of Low-Income Families	IC Document

IC Title:

Potential PFL-eligible low-income mothers

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Electronic Capability
Other-focus groups	No	Paper Only
Other-survey	No	Printable Only
Other-questions	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 80

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	80	80
Annual IC Time Burden (Hours)	73	73
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SS part B: Exploring the Relationship between the CA Paid Family Leave Program and the Well-Being of Low-Income Families		01/13/2016
Support St. A: Exploring the Relationship between the CA Paid Family Leave Program and the Well-Being of Low-Income Families		01/13/2016
Mini SS: Exploring the Relationship between the CA Paid Family Leave Program and the Well-Being of Low-Income Families		01/13/2016

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

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