Baseline Information Form

Evaluation of Strategies Used in the TechHire and Strengthening Working Families Initiative Grant Programs

Documents and Forms

Document Name Document Type
Baseline Information Form_updated.docx Other-Baseline information
TechHire Informed Consent Form_updated_1-17-2018.docx Informed Consent form IC Document

Information Collection (IC) Details

IC Title:	Baseline Information Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Baseline information			Baseline Information Form_updated.docx		No		Printable Only

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	600	600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Informed Consent form	TechHire Informed Consent Form_updated_1-17-2018.docx	01/24/2018

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