Information Collection

HPOG-Impact 72-Month Follow-up Survey

IC 227177 under ICR 201706-0970-003 · OMB 0970-0394.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0394 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HPOG Followup OMB Appendix B 72 Month Follow-up Survey 5-24-2017.docx	Other-Survey

IC Title:

HPOG-Impact 72-Month Follow-up Survey

Agency IC Tracking Number:

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
Other-Survey			HPOG Followup OMB Appendix B 72 Month Follow-up Survey 5-24-2017.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 987

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	987	987
Annual IC Time Burden (Hours)	740	740
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.