Baseline

CABHI Evaluation Client & Stakeholder Surveys

OMB: 0930-0320

IC ID: 195854

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Baseline
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Baseline Baseline Attachment 1. CABHI_Client Baseline Interview.doc Yes Yes Fillable Fileable

Health Public Health Monitoring

 

5,827 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 5,827 0 0 -58 0 5,885
Annual IC Time Burden (Hours) 2,447 0 0 505 0 1,942
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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